(BQ) Part 2 book “Oxford textbook of spirituality in healthcare” has contents: Psychiatry and mental health treatment, social work, care of elderly people, palliative care, care of the soul, next steps for spiritual assessment in healthcare, spiritual experience, practice, and community,… and other contents.
CHAPTER 30 Nursing Wilfred McSherry and Dr Linda Ross Introduction This chapter presents an overview of the historical and contemporary development of spirituality and spiritual care within nursing The chapter commences with a historical perspective of nursing care drawing attention to the medical and holistic models that have existed This is followed by an analysis of the key arguments that provide a basis for spiritual care within nursing This section reviews some of the primary drivers; political, professional and societal, resulting in nursing engaging with spiritual aspects of the person It is acknowledged that the concepts and debates outlined in this chapter have a relevance to nursing globally There is an increasing recognition of the importance that the spiritual part of an individual's life may make to health, wellbeing, and recovery A significant evidence base to support this is emerging, for example the pioneering work of Koenig et al.[1] The importance of nurses addressing the spiritual dimension is also reflected in some of the healthcare guidance at world, European, and national levels These issues are discussed in more detail in Ross.[2] Historical perspective Historically, in the West the sick were looked after in religious orders The body and spirit were cared for together, signifying the practice of truly holistic care at that time, i.e care of the body, mind, and spirit, where the whole is more than the sum of the parts There then followed the ‘period of enlightenment’, with all that brought with it, including an escalation in medical research, and knowledge and prevalence of a medical model of treatment which focused on disease processes and cures, rather than the spirit This medical model still prevails today within many health care services across the world However, it could be said that, until recently, nursing has never lost sight of the holistic concept of care, which has remained at the heart of the profession right through to the current day This unswerving focus on the whole person is a constant core and founding principle shaping and influencing how nursing is defined, practised and taught as shown in the next section Nursing is also in the process of developing its own evidence base for spiritual care Above we implied that nursing has maintained its focus on the holistic concept of care However, in the United Kingdom (UK) at present, there is concern that nursing may be in danger of losing sight of this focus moving away from the founding principles on which it is based The need to refocus on these core values of nursing, such as care, compassion, dignity, respect is evident in a number of reports where the quality and standard of nursing care are criticized [3–8] In these reports nurses are accused of treating individuals without dignity and respect Claire Rayner (the late President of The Patients Association in the UK) wrote: For far too long now, the Patients Association has been receiving calls on our Helpline from people wanting to talk about the dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment their elderly relatives had experienced at the hands of NHS nurses.[4, p 3] For nurses to be described in such derogatory terms is of great concern, since it implies that the core principles, beliefs, and values that underpin nursing have been eroded, lost and misplaced within contemporary nursing practice While these reports have been published within the UK the ramifications and lessons to be learnt are of international relevance, since they bring into question the public's image of the nursing profession, and the need for nurses to re-establish the fundamental principles of care and caring Basis for spiritual care within nursing Definitions of nursing The International Council of Nursing[9] defines nursing as: Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles This definition emphasizes the importance of nurses working collaboratively with the individual to establish their needs The definition underlines and reinforces the importance of nursing adopting a holistic and patient centred approach to care which is at the heart of the American Holistic Nurses Association mission statement.[10] Florence Nightingale considered that ‘the sick body … is something more than a reservoir for storing medicines’.[11, p 36] This sentiment is still evident in the Royal College of Nursing's (RCN) most recent definition of nursing, where nursing is defined in terms of its key functions These are concerned with promoting, improving and maintaining health and healing, helping people to cope with health problems, and to achieve the best possible quality of life The nurse's focus is on the whole person and their response to health, illness, disability which includes their spiritual response Spiritual support is identified by the RCN as a key part of the nurse's role.[12] In addition the first of the 8 new principles of nursing practice is concerned with dignity, respect, individual need and compassion.[13] Models of nursing In an early model of nursing, Virginia Henderson said it was the duty of the nurse to assist the patient to ‘worship according to his faith’ (p 13) and to ‘practice his religion or conform to his concept of right and wrong.’14, p 19] More recent nursing models also incorporate the spiritual For example, Jean Watson talks about the caring presence of the nurse and focuses on transcendence and the quest for meaning in life in her model.[15] One of the most commonly used models of nursing, the Activities of Daily Living (ADL) model[16] considers spirituality as a factor influencing ADL's and spirituality features specifically under the ‘death and dying’ ADL Yet other models address the spiritual through their focus on meaning, wholeness and/or transcendence Oldnall[17,18] suggested that the assertion that most nursing models have a holistic approach to care is inaccurate This is because, up until recently, some nursing models and theories, while espousing and embracing the mantra of holistic care, do not explicitly address the spiritual dimension McSherry[19, p 79] offers a possible explanation for this: Models should not be solely developed in the ‘ivory towers of academia’ and then be expected to work in practice This top-down approach to theory development may overlook and fail to incorporate many issues that are being faced by nurses working on the front line This approach may have prevented the spiritual dimension from being incorporated within contemporary nursing theories and models.’ Martsolf & Mickley[20] undertook a detailed review of some modern nurse theorists’ ideas concerning spirituality Their review sheds light on two key areas: The contribution to nursing knowledge made by some of the contemporary nurse theorists The position that spirituality has within those ideas; whether implicit or explicit It is beyond the scope of this chapter to provide a full critique of the place spirituality holds within each model It is sufficient to say that, within nursing models and theories, the importance of the spiritual dimension for individual health and wellbeing is now recognized Codes of ethics and education guidelines Spiritual care is central to nursing Codes of Ethics, both internationally and within the United Kingdom (UK) The International Council of Nurses (ICN) Code of Ethics for Nurses states:[21, p 2] In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected The Australian Nursing & Midwifery Council[22] accepts and builds upon the ICN Code In the UK, the Nursing and Midwifery Code of Professional Conduct states that: ‘You must treat people as individuals and respect their dignity.’[23] Unlike the ICN code[21] the spiritual dimension is not explicit, but implicit within the NMC (2008) code (and its associated publications) through the use of the words ‘individual’ and ‘respect for dignity.’ Therefore, failure to include a spiritual dimension within nursing and recognizing the importance of this for some individuals, may lead to a violation of an individual's fundamental human rights The NMC further expects that at point of registration newly qualified graduate nurses should be able to: ‘Carry out comprehensive, systematic nursing assessments that take account of relevant physical, social, cultural, psychological, spiritual, genetic and environmental factors …’.[24, p 18.] The Essential Skills Clusters for pre-registration nursing programmes identifies ‘skills that are essential’ in order to be ‘a proficient nurse.’ Included under the ‘Care, compassion and communication’ cluster is the expectation that the nurse will ‘demonstrate an understanding of how culture, religion, spiritual beliefs … can impact upon illness and disability.’[24, p 108] This is a similar expectation of the Quality Assurance Agency for Higher Education which expects nurses to be educated to: Undertake a comprehensive systematic assessment using the tools/frameworks appropriate to the patient/client taking into account relevant… spiritual needs Plan care delivery to meet identified needs Demonstrate an understanding of issues related to spirituality.[25, pp p 10, 12] Despite the above guidance, there is great variation in the amount and nature of the spirituality component within nurse education programmes Despite these inconsistencies, there is evidence that spiritual care teaching is gaining more attention as evidenced by the increasing numbers of papers debating the many issues and dilemmas raised Currently, a great deal of work has[26–28] and is being done (a current doctoral level study is in progress) to establish competencies in spiritual care for nurses and midwives at point of registration This is a much needed development Spiritual care: what is it and what does it look like? If one looks at the evolution of spirituality and spiritual care in nursing then there is a noticeable shift in emphasis and direction Much of the early pioneering work sought to elucidate and define the concept at a macro level Macro in this instance, means applying generally and universally to the nursing profession This early work was concerned with understanding the meaning and perception of spirituality, and the practice of spiritual care and much of it was American.[29–31] The emphasis now is not so much on elucidation of the concept, but about practical relevance and application Nurses are now engaging with the concept at a micro-level Micro- meaning they are trying to apply the general principles of spirituality and spiritual care and developing knowledge and understanding specific to their own sphere of practice be this mental health, orthopaedic or critical care nursing This micro approach has seen nursing focus on spiritual assessment within the different branches of nursing Spirituality The spiritual dimension is deeply subjective and there is no authoritative definition of spirituality.[32] Swinton and Pattison[33, p 236] affirm that it is probably more beneficial for nursing not to have a definitive definition when they write: ‘As a matter of fact, it is probably important that spirituality remains a contested and functional concept rather than becoming consolidated if it is usefully to denote the kinds of contextual absences that need to continue to be recognized and worked with.’ However, when one looks at the range of definitions of spirituality across disciplines involving diverse groups of people with differing worldviews, there seem to be common attributes, namely: hope and strength; trust; meaning and purpose; forgiveness; belief and faith in self, others, and for some a belief in God/deity/higher power; values; love and relationships; morality; creativity and self-expression Given this broad concept of spirituality, what then does spiritual care look like? And how can it be given? Recent criticisms The concept of spirituality and its place within nursing has been the subject of recent debate and criticism The spirituality-in-nursing debate has been accused of insularity; that is it has not drawn sufficiently on the established body knowledge of other academic disciplines, meaning it has lacked the external scrutiny or peer review from groups of people from outside of nursing such as theology, psychology, philosophy, sociology and religious studies This is an important point since many of these disciplines have engaged with the concept of spirituality over many centuries and they have a wealth of knowledge and skills that shed valuable light enabling a deeper understanding of the concept However, while nursing must and should draw upon the wealth of knowledge generated by such disciplines it must not be held ransom by them, in that they are not the sole avenues of knowledge and understanding Nursing must continue to plough its own furrows with regards to spirituality and its application to nursing, however being mindful of the important contribution other disciplines can make to helping nursing understand and expedite this field of enquiry A further criticism of the spirituality-in-nursing debate has been the perpetuation of concepts theory and definitions that have not been developed within the context of empirical study One example of this is the uncritical and almost universal adoption of a definition of spirituality first presented by Murray and Zentner.[34] This definition was used uncritically and unchallenged by nursing scholars and academics, especially within the UK A further concern raised has been the relationship of spirituality with other humanistic aspects of the individual, such as psychosocial care Clarke[35] proposes that nurses have always addressed the spiritual concerns of individuals which were accommodated within the psychosocial domain Clarke35, p 1672] suggests that the reason for the inability to distinguish between the spiritual and psychological domains is that the model of spiritual care developed by nursing is ‘… too large, too existential and too inclusive to be manageable in practice without being indistinguishable from psychosocial care.’ For nursing research into spirituality to be more representative then it must seek to be more heterogeneous.[36] This point is made because, if one reviews the many studies undertaken in this area, the samples are often homogenous, lacking religious, ethnic, and cultural diversity, primarily reflect a JudeoChristian perspective and often only focus on key groups, such as nurses, chaplains, and patients There is a need for the nursing profession to be more inclusive, ensuring that study samples reflect the diversity of people, cultures, and groups within contemporary societies One of the positive outcomes of the recent debates associated with spirituality is that nursing scholars, researchers, and practitioners are more cautious and aware of the need to be analytical and critical, if concepts are to be developed in a meaningful and rigorous manner Therefore, as Swinton[37] points out, nurses do need enemies, not to be confrontational, but to assist in the development and refinement of concepts so that these will be better constructed and understood Some of the contemporary criticism raised within the nursing literature related to spirituality and spiritual care have been summarized in a recent article written by Swinton and Pattison.[33] This article offers a positive way forward for nursing in understanding and applying the concepts of spirituality and spiritual care within nursing practice The following quotation presents succinctly the outcome of recent controversy and where a solution may be found outlining the direction for future activity: ‘We suggest that instead of arguing about whether or not spirituality can exist in any realist, essential sense—a line of argument that has proven to be somewhat circular, controversial, and unhelpful—it is more useful to develop a thin, vague, and functional understanding of what this word and its cognates might connote and do in the world of health care.’ (p 227) Spiritual care For some people, the experience of illness, the uncertainties about diagnosis and the possibility of disability or even death may trigger spiritual distress It has been said by Granstrom that: ‘Many individuals do not seriously search for meaning and purpose of life, but live as if life will go on forever Often it is not until crisis, illness … or suffering occurs that the illusion (of security) is shattered … Therefore illness, suffering … and ultimately death by their very nature become spiritual encounters as well as physical and emotional experiences.’[38, p 26] Karl Jaspers[39] calls such encounters ‘limit situations,’ i.e situations that we cannot change and cause us to think about what is really important in life Questions like ‘Why is this happening to me?’, ‘Am I going to die?’, ‘What lies after death?’ may be triggered, and cause existential, spiritual distress Nurses are often the first point of contact for people facing such challenges It is important, therefore, that they are equipped to be able to respond appropriately in such circumstances Spiritual care has been defined as: ‘That care which recognizes and responds to the needs of the human spirit when faced with trauma, ill health or sadness and can include the need for meaning, for self-worth, to express oneself, for faith support, perhaps for rites or prayer or sacrament, or simply for a sensitive listener Spiritual care begins with encouraging human contact in compassionate relationship, and moves in whatever direction need requires.’[40, p 6] Giving spiritual care The practice of spiritual care is about meeting people at the point of deepest need Some pointers are given in Box 30.1 and have been adapted from the RCN Pocket Guide which the authors helped to produce.[41] Of course our own values and beliefs are very dear and personal to each one of us This can cause conflict for nurses in their dealings with patients, clients and families, particularly if the latter's life view differs from that of the nurse When this happens we often hear about it in the media Some examples of recent UK headlines and their knock-on effect are given in Box 30.2 Box 30.1 Some pointers for giving spiritual care Spiritual care is about: Not just ‘doing to’, but ‘being with’ the person The nurse's attitudes, behaviours and personal qualities i.e how he/she relates to the person Treating spiritual needs with the same level of attention as physical needs Skills that are useful include (from the research on nurses and patients): Adopting a caring attitude and disposition Showing empathy Watson (15) referred to this as the ‘caring presence of the nurse’ Being respectful Recognizing and responding appropriately to people's needs Being sensitive Giving time to listen and attend to individual need Good communication skills Being aware of when it is appropriate to refer to another source of support e.g chaplain, counsellor, another staff member, family or friend Ability to remain fully present in the face of suffering Being personally hope-filled, believing that what one does and what one is always of some value Knowing that it is never too late to do good Assessing spiritual needs Just as a nurse would assess patients’ physical needs, so an initial assessment of patients’ spiritual/religious concerns is also important Assessment may take different forms It may involve, for example: Using observation to identify clues that may be indicative of underlying spiritual need, e.g peoples’ disposition (sad/withdrawn), personal artefacts (photographs, religious/ meditational books and symbols) Using questions to open the area up for discussion The following are examples: Do you have a way of making sense of the things that happen to you? Would you like to see someone who can help you talk or think through the impact of this illness/life event? (You don't have to be religious to talk to them) What sources of support/help do you look to when life is difficult? (Would you like to see someone who can help you?) It will usually involve some form of documentation within the nursing notes and care plan as part of the wider nursing process Knowing when to seek further help: It is important to know your strengths, limitations and when to seek help (42) There is nothing wrong with referring to someone else, e.g colleague, mentor/preceptor, chaplaincy team (who are there for staff and patients of all faiths and none), counsellor, psychologist This media interest resulted in two of the biggest ever surveys of nurses by the Nursing Times[42] (which attracted more comments and views than any other story to date) and the Royal College of Nursing[43] whose survey had the 2nd largest response to a survey by its members These response rates underline the importance nurses place on spiritual aspects of care and on the general interest nurses have in these concepts The overwhelming message from both surveys was that nurses recognize the importance of spiritual care, but want more guidance on spiritual care practice, particularly in relation to the conflict between their own personal beliefs/values and their professional practice Here, are some key findings from the RCN survey.[44] Of the 4054 members who responded: 83.4% agreed that spirituality and spiritual care are fundamental aspects of nursing care 90% believed that providing spiritual care enhances the overall quality of nursing care Only 4.3% felt that it was not the nurses role to identify patients spiritual needs 79.3% agreed nurses not receive sufficient education and training in spirituality 79.8% felt that spirituality and spiritual care should be addressed within programmes of education 78.8% felt the provision of guidance and support should come from the NMC While 78.1% felt that the RCN also have a responsibility in this area The RCN commissioned a Task and Finish group (which the authors were part of) to produce guidance for nurses tackling some of the key concerns raised above by participants in the survey about this important part of care This guidance is in the form of a ‘Pocket Guide’ and on-line resource.[45] A checklist of things to think about before responding to patient/client spiritual need is given in these resources Evidence base Nursing practice today should be based upon research evidence The evidence base for spiritual care within nursing is fairly new, but has escalated in recent years For instance a literature review conducted by LR in the late 1980s/early 1990s showed that there was very little published research on spirituality by nurses at that time, with only one American published study.[46,47] Most unpublished Masters work was also American in origin When this review was repeated in 2006, 45 original research papers were identified for the period 1983–2005 Whilst much of this research was still American, the number of countries had expanded to include the UK, other European countries, Scandinavia, Australia and Japan The full review is published,[45] but in brief showed that on the whole nurses consider spiritual care to be an important part of their role, but they feel unprepared for it, feeling in need of further education and training They also tend to focus on the more obvious religious part of care which in many ways is easier to deal with than the broader aspects of spiritual care Box 30.2 Some recent media headlines ‘Nurse suspended for prayer offer’[48] ‘Nurse sacked ‘for advising patient to go to church’ (News, 26 May 2009)[49] ‘Muslim nurses CAN cover up, but Christian colleagues can't wear crucifixes’ (Mail Online, 19 Oct 2010)[50] ‘British Medical Association to debate religion and prayer in the NHS’ (News 29 June 2009)[51] Integrating personal belief and professional responsibility The nurse's own personal spirituality seems to have a bearing on how spiritual care is delivered This can be illustrated by referring to two cases that gained considerable media attention in the UK: one involved the suspension of a nurse who offered to pray for a patient The nurse had been caring for a woman in the community and as she left asked if the lady would like her to pray for her The women said ‘no’ Subsequently, the lady complained to the Trust and the nurse was suspended pending an investigation Her suspension was on the grounds that she had not followed her code of professional practice specifically around the use of professional status; promoting causes that are not related to health The nurse was later reinstated, after public outcry that political correctness has been taken to extremes with her suspension.[for more details see 48] The other case concerned a nurse who refused to remove a crucifix which she qualitative research 315–16 sampling and measurement 310 spiritual non-religious and historical methods 317 theory 311 mind-body interventions 192, 193–4 meditation 193–4 yoga 38, 70, 169, 194 mindful-awareness 276–7 mindfulness 13 mindfulness meditation 194, 362 minority religions 317–18 miracles 7, 469 models biopsychosocial 178, 198 biopsychosocial-spiritual 259–60 dignity 147–8, 147, 285, 286–7 health 177–8, 180 health beliefs 115 healthcare 491 nursing care 212 professional caring 139–40 professional formation 453 quality of life 157, 158 social health 179–80 spiritual assessment 299–300, 301 spiritual care 177–83, 198 spiritual history-taking 301 total pain 265, 274 training 453 use of 177 modern spirituality 169–70, 171–2 Moltmann, Jürgen 28 Mondrian, Piet 171 moral behaviour 348, 349 Moriarty, John 276 motivation 140 multidisciplinary team 265–6, 460 see also teamwork Murdoch, Iris 27–8, 267 music 255, 268 Nagel, Thomas 488 narrative 182, 239–40 National Association of Catholic Chaplains 385, 430, 432 National Association of Jewish Chaplains 385, 430, 432 National Care of the Dying Audit 343 National Center of Complementary and Alternative Medicine 191 National Comprehensive Cancer Network 202–3 National Consensus Project for Quality Palliative Care 199, 385 National Council for Palliative Care (UK) 266 National Initiative to Develop Competencies in Spirituality for Medical Education (USA) 420–1 National Quality Framework 385 Native American spirituality 412 natural law 5 negative religious coping 128 neural representation 350 neurobiology 369–70 neurotheology 350–1 New Age spirituality 8, 69–76, 474 healthcare 69–70 spiritualities of life 70–3 Romantic 72–3 South Asian 70–2 tradition 74–5 Newberg, Andrew 359 Niebuhr, Reinhold 431 Nightingale, Florence 7, 211–12, 219 nirvana 12 nomothetic knowledge 99–100 non-abandonment 140–2, 207, 467 non-persons 107–8 North American Nursing Diagnosis Association 422 Northern Ireland Healthcare Chaplains Association 384 Northup, Lesley 32 noticing, as cognitive skill 277 numina 5 nurses compassion 136 competencies for spiritual care 437 faith community 219–26 personal belief and professional responsibility 215 nursing care 211–17 assumptions and expectations 215 definitions of 211–12 ethics and education guidelines 212 historical aspects 211 models of 212 practice of 215–16 spirituality in 212–14 criticisms of 213 spirituality teaching 419, 422 Nursing and Midwifery Code of Professional Conduct 212 observational studies 313–15 occupational standards 438–40 occupational therapists, spirituality teaching 422–3 Ojibwe people 51–2 minobimaatisiiwin 51 old age, Buddhist concepts of 14–15 older people 251–6 care environment 255 care of 255 final life meanings 253 hope 253–4 independent living 252 mental health 251 dementia 109, 251 depression 251 relationship and connectedness 252–3 response to meaning 254–5 spirituality 251–2 ageing process 252 assessment 252 growth and care 252 suffering 160 transcendence and transformation 253 online communities 377–8 organizational spirituality 391–6 definition 392 elements of 393–5 availability and compassion 393–4 caring physicians 394 inclusion, empathy and confirmation 394 social justice 394–5 healthcare setting 392–3 ‘other’ 47, 109–10 outreach 490–1 pain 28 painting 171, 255 palliative care 198–9, 257–63 definition 257–8 dignity in 146–7 holistic 238 Liverpool Care Pathway for the Dying Patient (LCP) 343, 460 quality of life 343 spiritual need 259 suffering 161–2, 258–9 supportive presence 260 see also spiritual care Pargament, Kenneth 302, 333 Parham, Charles Fox 7 parish nurses see faith community nurses pastoral care 294–5 classical clerical 294 clinical 294 communal contextual 294 intercultural post-modern 294 WHO categories 401 Pastoral Care Networks Project (Australia) 453–5 pastoral counselling 423, 424, 425 pastoral theology 293–7 chaplains see chaplaincy services; chaplains compassionate care 297 core tasks 295 methodology 294–5 spiritual aspects 293–4 patient-centred care 108, 198, 466 patienthood 106–7 peak experiences 446 Pentecostalism 7, 482 Perry, Christopher 288 personal belief 215 personal growth 224, 470 personal spirituality 228–9 personal unconsciousness 273 personality 105–6 personhood 105–11 body/mind/spirit 106 compromise of 107–8 definition 105–6 and power 108–9 staff 108 vs patienthood 106–7 Petrie, Caroline 85 pharmacists, spirituality teaching 423 phenomenology 318 philanthropy 6 philosophy 77–82, 488 adverse conditions 79–80 disease 78–9 health 78 human flourishing 77–8 religious belief 81–2 spirituality 80–1 physical health 131 physical therapists, spirituality teaching 422–3 physical wellbeing 157–8 physician assistants 422 physician-assisted suicide 147 physicians behaviour 289 caring 394 conscientious objection 84 role in spiritual care 199 Piaget, Jean 244 piety 61–2 harmonial 317 pilot studies 311–12 placebos 116–17, 370 Plato 43–4, 44 poetry 255, 269 positive religious coping 128, 130 post-Christianity 475–6 post-traumatic growth 27 power, personhood and 108–9 prayer 64, 359–65 and health 360–1 intercessory 360–1 with patients 469 proximal 194 prejudice 337 presence 260 preservation of life 65 pride 147 primary healthcare 220–1 professional authority 303 professional capabilities 438–40 professional formation 443–9, 451–7, 490 context 444–5 definition 443–4 model of 453 see also training professional responsibility 215 professionalism humanity in 449 rule-based 447 Prometheus 45 propensity to illness 370, 370 property dualism 79 propositional knowledge 114 proselytizing, prohibition of 467–8 prosocial actions 348–9, 351 protection 401–2 Protestantism 4 proto-sacrality 74 proximal prayer 194 Pruyser, Paul 299, 302 psychiatry 227–33 Psychological Measure of Islamic Religiousness 337 psychological wellbeing 130, 158 psychologists, spirituality teaching 422 psychosis 231–2 purity 53 qi gong 169, 362 qualitative research 315–16 quality of life 316, 341–6 City of Hope model 157, 158 definition 341 health-related 153 palliative care 343 spiritual wellbeing 158, 327, 341–3 tools for assessment 343–4 randomized controlled trials 313 Rao, Anand 85 rationality 107 Reeve, Christopher 106–7 reflective practice 296, 455 critical reflection 452–3 relational ill-health 52–3 religion 11, 101–2, 169–74 in counselling 280 definition 169, 333–5 future of 481–6 group-based 230 and health 333–9 in healthcare 85 meaning making and coping 101–2 measurement 333–5 and prejudice 337 psychology of 335–7 in secular society 484–5 spirituality as alternative to 171 unusual/idiosyncratic expressions of 231–2 values in healthcare 484–5 see also entries under spiritual/spirituality religiosity 81–2 as coping strategy 328 as resource 328 and suicidality 128 see also entries under spiritual/spirituality religious belief 81–2, 114 origins of 348–9 religious coping 337 see also spiritual coping Religious coping (Brief RCOPE) 328 Religious Fundamentalism Scale 336 religious healing 7 religious identity, respect for 227–8 religious involvement 335–6 religious motivation 337 Religious Orientation Scale 334 Religious Struggle Screening Protocol 300 religious well-being 354 research measures 310, 323–31 on meditation 363–4 methodology 309–22 resilience 148, 229, 369–71, 371 building 370–1, 370 restorative medicine see spiritual care Rice, A.K 431 Rich, Adrienne 35 Rinpoche, Sogyal 15 rites of passage 165–6 life-force 165–6 ritual 163–8, 254, 348 choice of 255 habitus 166 healthcare contexts 164 power and hope 163, 164–5 in relationships 166 rites of intensification 164 and symbolism 163 symbolism 166 of blood 167 times to use 254–5 ritual purity 53 ritual space 166–7 Rogers, Carl 279, 281, 282, 443, 447–8 education 448 interpersonal relationships 448 role preservation 147 Rolston, Holmes 477 Roman Catholicism 4 medical charities 7 religious healing 7 Romanticism 72–3 Royal College of Psychiatrists, Spirituality and Psychiatry Special Interest Group 282 rule-based professionalism 447 sacred 73, 75 St Christopher's Hospice 257, 265 changes and challenges 266 spiritual care 266 salvation and healing 26–7 Santa Clara Strength of Religious Faith Questionnaire 326 Saunders, Cicely 257, 265, 289, 343, 485 Savulescu, Julian 84–5 Schneiders, Sandra 473 Scottish Association of Chaplains in Healthcare 384 Scribonius Largus 6 secular spirituality 83, 317, 473 secularism 73, 83–8, 170, 473 chaplaincy provision and funding 86–7 conscience and controversy 84–6 meanings of 83 separation from religion 83 toleration of religion 84 secularization 7–8, 170 self-actualization 392–3 self-care 224 self-empathy 276 self-knowledge 276 self-restraint 22 self-transcendence 351, 391, 475 Selye, Hans 367 Selznick, Philip 484–5 Seneca 8 sexuality feminist 34 in older people 253 shamans 52 Siddhartha Gautama (Buddha) 13 Sikhism 89–96 abstinence and diet 91–2 body and mind 93–4 core teaching 90 diversity of belief 91 dying, death and bereavement 94 five Ks 91 illness concepts 94 izzat 92–3 modernity 93 Panjabiat 92–3 protection from harm 92 religious sensitivities healthcare professionals 95 hospital chaplains 94–5 scriptures 90 turban 91 Simmel, Georg 76 Situpa, Tai 15 Skinner, B.F 46 social care 409–16 education and training 412–13 ethical practice 413–14 policies 412 spiritual leadership 413 spirituality in 409–12, 410 see also spiritual care social context 454 social health models 179–80 spirituality in 179–80 social justice 237, 394–5 social organization 180–1 social wellbeing 158 social work 235–41 engagement with spiritual care 235–7 and healthcare 237–40 end-of-life care 238 social worker as companion 238–9 use of narrative 239–40 spirituality teaching 422 sociology 317–18 Socrates 43, 44 soul 106 care of 273–8 of medical students 446–7 vs spirit 445–6 soul-language 445 soul-making 475 South Asian spiritualities 70–2 spirit 106 vs soul 445–6 spiritual assessment 205, 299–305, 468 context 302–3 models of 299–300, 301 spiritual history-taking 299 spiritual screening 299, 300 normative issues 302 older people 252 and professional authority 303 quantification 302 research 300–1, 301 spiritual beings 51 spiritual belief 114 spiritual care 110, 197–210, 213–14 barriers to 206–7 chaplains see chaplaincy services communicating with patients 203 compassionate presence 138–9, 140–1, 207 ethical justification 465–6 ethical principles 198, 465–70 clinical notes 468 confidentiality 468 discretion 467 family and friends 469 holism 70, 466–7 life-long learning 469–70 miracles 7, 469 non-abandonment 467 patient-centredness 198, 466 personal spiritual development 470 praying with patients 469 prohibition of proselytizing 467–8 tolerance 467 evaluation and outcomes 414 and healthcare 181 history 197 interdisciplinary teamwork 265–6, 459–64 in Islam 62 levels of 451–2 models 181–2, 198 biopsychosocial 198 narrative development 182 operational 181–2 patient-centred 198 in nursing 212–14 older people 252 outreach 490–1 physician's role 199 policy and guidelines 198–9 practice of 213–14 provision of 413 resources of strength 201–2 shared definition 266–7 and social work 235–7 tradition of 180–2 who should provide 461–4, 489–90 Spiritual Care Consensus Conference 385, 419 spiritual care policy 383–9 Australia 386 governance 387–8 implementation 388 public input 387–8 UK 383–4 USA 384–6 spiritual carers 397–407, 398 accreditation 403 appointment 402 commissioning of 402–4 professional capabilities 404 remuneration 403–4 roles of 398–402 communication 398–9 economic utility 402 multi-purpose/multi-competent 399–401, 400, 401 protection and advocacy 401–2 public service 398 see also chaplaincy services; chaplains spiritual communities 377–8 spiritual coping see coping spiritual diagnosis 201–2, 202, 203 decision pathways 204 spiritual direction 423 spiritual distress 202–3, 202 spiritual goals 410–11 spiritual history 205, 299 spiritual leadership 413–14 spiritual meaning making 129–30 spiritual needs 259, 328–9 Spiritual Needs Inventory 328–9 Spiritual Needs Questionnaire 329 spiritual pain/suffering 258–9 spiritual practice 260, 376–7 and community 375–6 limits to 379 spiritual screening 203–4 Spiritual Transformation Scale 327 spiritual treatment plan 205–6, 207 documentation 207 Spiritual Well-Being Questionnaire 327 Spiritual Well-Being Scale 327, 353–8 applied use 355 healthcare practice 357 mental health 356–7 mental health predictors 356–7 origins of 353–4 physical health predictors 355–6 subscales and properties 354 translations 354–5 spiritual wellbeing 158, 327, 341–2, 341–3 spiritual worldview 237 spiritual/religious attitudes 326–7 spirituality 11, 102–3, 213, 341–3 as alternative to religion 171 children 244–5 in clinical care 199–201, 200, 201 cognitive sciences viewpoint 348–50 contemporary 473–9 as coping strategy 328 in counselling 280 as cultural wisdom 163 curriculum development 417–27 definitions 235–6, 243–4, 258, 302, 391–2, 411 linguistic 316–17 and dignity 145 Eastern discovery of 172–3 success of 173–4 European 170–1 feminist 31–6 future of 487–508 gaps within current healthcare practices 103 grass roots 376 and habitus 166 and health 351–2 ideographic nature of 103 modern, origins of 169–70 and modernity 171–2 neurotheology 350–1 New Age 8, 69–76 organizational 391–6 patient communication 203 personal 228–9 philosophy 80–1 psychology of 335–7 redefinition of 475–6 as resource 328 secular 83, 317, 473 in social care 409–12, 410 and social organization 180–1 and suffering 157 understanding of 488 see also healthcare spirituality Spirituality and Health Online Education and Resource Center 301 Spirituality and Psychiatry Special Interest Group 424 spiritually sensitive practice 378 Spretnak, Charlene 33 SpREUK 328 Sri Madhava Ashish 275, 277 Standards for Hospice and Palliative Care Chaplaincy Association 259 Stein, Edith 29 stigma 227 Stoicism 6, 8, 77 story-telling 394 strength, sources of 201–2 stress 229, 355 acute 161 pathogenic 367 physiology of 367–9 stress response 367 central nervous system 368 hypothalamus-pituitary-adrenal axis 367–8 immune system 369 neurocircuitry of fear 368–9 subjectivity 47 suffering 157–62, 161, 258–9, 446 acute illness 161 children, adults and older people 159–60 chronic illness 161 compassion in 138 domains of care 157–8, 158 physical wellbeing 157–8 psychological wellbeing 158 social wellbeing 158 spiritual wellbeing 158 family caregivers 160 healthcare practitioners 160–1 palliative care 161–2 positive value of 5–6, 8, 27–8 and spirituality 157 tenets of 158–9 suicide 356 in older people 254 physician-assisted 147 Swinton, John 281 symbolism 163, 166 of blood 167 symbols 254 choice of 255 times to use 254–5 systematic reviews 312 taboos 348 Tagore, Rabindranath 71–2, 172–3 tai chi 194, 362 Tao te ching 20 Taoism 19–24 concepts of health 21–2 Daode jing 22 healing historical aspects 23 modern concepts 23–4 Neiye 21, 22 Quanzhen 22–3 spiritual practice 20–1 Taiping jing 23 Western misrepresentation of 19–20 world view 20 Tawhai, Te Pakaka 50 Taylor, Charles 484 Taylor, Jeremy 8 Taylor's Model of Professional Caring 139–40 teamwork 459–61 accountability 461 ethical and legal issues 461, 468–9 inter-disciplinary team 460–1 multidisciplinary team 265–6, 460 provision of spiritual care 461–4 terror management theory 274 theodicy 5–6 theory of mind 349–50 therapeutic touch 194 thinghood 105, 109 Thorne, Brian 279, 282 Tillich, Paul 294, 431 tolerance 467 total pain model 265, 274 Tracy, David 294 tradition 50, 74–5 traditional Chinese medicine 8, 192 acupuncture 194–5 training 448, 490 capabilities 439–41 clinical pastoral education 423, 424, 429–33 competence-based 435–41 benefits 435–6 framework development 436–8 history 435 limitations 436 continuing professional development 426 critical reflection 452–3 key elements 453–5 model of 453 need for 452 occupational standards 438–40 Pastoral Care Networks Project 453–5 professional formation 443–9, 451–7 social care 412–13 spirituality and health 417–27 transcendence 46–7, 236, 309, 354, 446, 454 older people 253 self-transcendence 351, 391, 475 transcendental meditation 362 transference 276 transformation 236–7 older people 253 transnational voluntarism 482 trauma, purpose and meaning 28–9 Trilling, Lionel 445 Trungpa, Chogyam 15 Tuohy, Caroline 387–8 Turner, Victor 165 Tylor, Edward 169 UK chaplaincy services 185–6, 186–7, 384, 424 End of Life Care Strategy for England 259 Equality Acts (2006, 2010) 412 National Council for Palliative Care 266 National Service Frameworks 412 spiritual care policy 383–4 spirituality and health training 423–4 uncertainty 122 USA chaplaincy services 186, 187–8, 385–6, 423 clinical pastoral education 429–30 National Initiative to Develop Competencies in Spirituality for Medical Education 420–1 spiritual care policy 384–6 spirituality and health training 417–23 utopia 73 value systems 29, 455 Van Ness, Peter 476 VandeCreek, Larry 432 Vattimo, Gianni 477 verbatims 294 Vigen, Aana Marie 33 visions 53 Vivekananda, Swami 172 volition 139 vulnerability 229 Wallace, Alan 277 Wallace, Alfred Russell 171 Watson, Jean 212 Weber, Max 46 welfare 483 wellbeing 51, 166 physical 157–8 psychological 130, 158 social 158 spiritual 158 Wesley, John 8 Westberg, Granger 220 Whitehouse, Harvey 165 women healthcare 33–4 reproduction 34–5 sexuality 34 World Health Organization International Classification of Diseases (ICD-10-AM) 400, 401 Quality of Life measure 341 wounded healers 260 Yalom, Irvin 431 yoga 38, 70, 169, 194, 362 York Retreat 73 Zahalon, Jacob 64 Zen Buddhist meditation 362 Zoroastrianism 3–4 ... most recent definition of nursing, where nursing is defined in terms of its key functions These are concerned with promoting, improving and maintaining health and healing, helping people to cope with health problems, and to achieve the best possible quality of life... http://www.patientsassociation.com/Portals/0/Public/Files/Research %20 Publications/Listen %20 to %20 patients, %20 Speak %20 up %20 for %2 (Accessed 17-1 -20 12) The Mid Staffordshire NHS Foundation Trust Inquiry (20 10) The Independent Inquiry into Care Provided... 12 Royal College of Nursing (20 03) Defining Nursing: Nursing is … London: RCN 13 Royal College of Nursing (20 10) The Principles Available at: www.rcn.org.uk/nursingprinciples (accessed 13 December 20 10)