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Stephen Wright and Julia Neuberger argue that 'engaged spirituality' is the key to preventing further cases of patient abuse and neglect
The regular articles published in Nursing Standard on spirituality are sometimes attacked by nurses who think the subject is a waste of time, nothing to do with nursing and certainly nothing to do with the scandals of poor nursing care.
But the spirituality we write of is an engaged spirituality, it is every bit to do with the essence of nursing practice, and certainly connected to what happens when things go wrong.
All belief systems, whether religious or otherwise, have something to say about what it is to be human. We are all much more than our jobs or roles or personalities. Spiritual practices such as prayer, meditation and reading scriptures cultivate deep reflection on the nature of 'I' and how best to be and act in the world. They seek to encourage a less egocentric view of ourselves in the world, to make us a part of the creation, with responsibilities towards the world we live in and to each other.
In fact, such practices often subvert notions of 'other'. Sometimes we can get stuck in limited ways of seeing each other - 'me nurse, you patient'.
If we come to identify too strongly with 'I am a nurse' and then something happens to our role, such as redundancy or a complaint, it can feel as though our whole life is under attack. Similarly, labels such as 'patient' can sometimes lead us to forget that he or she is a human being, just like us.
Sense of separateness
Viewing patients through this lens of separateness means we can feel under attack when they become demanding or needy. That sense is heightened if we feel uncertain about our ability to do the job, or do not feel supported by our boss or the organisation. We may then seek to defend ourselves from our responses to patients. Under such pressure, we may not only look and seem uncaring to patients, but actually find excuses to avoid contact with them, or even worse, assault and harm them verbally or physically.
'They' cease to be human like us, instead becoming aliens without the same feelings or understanding as ourselves. Patients become wholly objectified, people to whom and for whom things must be done.
Unless we have become mature, well-rounded human beings with insight about always needing to see ourselves and others as fully human, the chances are that, under pressure, we will start to operate in ways that are uncaring.
This decision to see others as separate from ourselves can be expressed as: 'You are different from me, I am on my own here.' The language of our deeper humanity (in some traditions our 'soul' or 'higher consciousness') says: 'We are the same, we are of one common creation, there is no "other".'
When we hold on to this kind of awareness or consciousness, we are much less likely to engage in attack or defence, simply because there is no 'other' to attack or defend against.
Spiritual work raises our awareness of our true nature and liberates us from limited understandings of self.
Nurses who are aware of these concepts, and who like being in the world of their work, will not harm patients simply because by caring for others they care for themselves.
They do not have to 'do' compassion. They just need to source their own deeply felt humanity from which compassionate action flows with ease and grace. Cruelty usually stems from the frightened self. Spirituality cultivates a deepening of our understanding of what it is to be human, of resources we can draw on to connect with and serve others. It encourages us to feel comfortable in the world and to be more likely to respond to the things life throws at us from a position of love and respect, rather than fear.
These are some of the main reasons why spirituality is every bit as relevant to patient-centred care as having the right skills and resources to do the job.
Nursing Standard has published a great deal of commentary and research on the relevance of spirituality and health down the years. Here we make a personal case for the spiritual wellbeing of the nurse.
Spirituality is by no means a nice fluffy side issue. It is integral to the wellbeing of all human beings, whether we are conscious of that need for reflection and wholeness or not. It is the lifelong process through which we find our centre in the world, how we establish our relationships, find love, meaning, connection. That is why an affirmation of spirituality in nursing at every level is long overdue.
The evidence base for such an approach was explored in the Nursing Standard series on spirituality and nursing back in 2008. Here we want to get across the message that spirituality is the key to minimising the profession's long history of patient abuse and neglect.
Transforming the inner process of the nurse is every bit as important as transforming the way we deliver care. After the highly successful Nursing Standard conference this spring on spirituality, health and nursing, it was clear that for many nurses and those who manage them, this subject is full of uncertainty and confusion.
We feel that it is time to set out a manifesto for nursing, rooted in the belief that an awareness of spirituality is an essential element in the wellbeing of nurses and patients.
Feature | Nursing Standard | June 6 | vol 26 no 40 | 2012
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This article presents the case for 'engaged spirituality' as the key to improving nurses' ability to cope under pressure and remain compassionate towards patients. The authors argue that it is not a luxury addition to care, but just as important as skills and resources.
A seven-point manifesto for spirituality in nursing sets out the place for spirituality in health care, and calls for changes in education and training to allow all nurses to see themselves and patients as one.
Stephen Wright and Julia Neuberger's seven-point plan for integrating spirituality into health care.
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