Spirituality in Nursing: The Neglected Ethic of Care
Nursing has long hailed holistic care as its cornerstone. If one thinks of giving holistic care, then the focus needs to be not only on physical care, but also on emotional, social, and spiritual care. Yet, the spiritual dimension of care tends to be neglected for many cited reasons: lack of education about how to incorporate such care into practice; lack of competence in incorporating spiritual aspects of care; confusion about what spirituality really is; perceived lack of time to address such care, and so on. However, if nurses are to fulfill the value and intent of holistic care, they must incorporate the spiritual dimension into their practice. This brief article will provide the rationale for spiritual assessment and care. Clear rationale should provide the motivation and commitment to not neglect this important ethic of care.
Why have I proposed in the title of this article that spirituality in nursing is a neglected ethic of care, or in other words, why is spiritual assessment and care part of ethical care? All nursing codes of ethics assume that spiritual assessment and care is part of nursing practice, and refer to spirituality as “an obligation of care.” For example, the International Council of Nurses Code of Ethics states that the nurse is to “Provide an environment in which the human rights, values, customs, and spiritual beliefs [of the client] are respected.” Inherent in these statements is the assumption that the client’s spiritual and religious beliefs are to be ascertained by the nurse. Otherwise, how can there be intentional sensitivity and respect for such beliefs? Furthermore, if you were to peruse the nursing literature, you would find that there is much discussion about going beyond the ‘respecting’ and ‘supporting’ of clients’ spirituality (as phrased in codes to ethics) to actual intervention in this dimension of care.[et_bloom_inline optin_id=optin_23]
Other than fulfilling the mandate for holistic care and codes of ethics, there is ample rationale for incorporating spirituality into nursing practice:
1. There is significant interest and discussion of the topic in health care and nursing: in articles, books, and dissertations focused on spirituality; in conferences related to client care; in a number of websites devoted to the topic; and in nursing education curricula.
2. In Western society, much attention has been devoted to the topic, in particular with respect to non-religious spirituality: multiple books have been written on the subject; workshops for the general population often include spiritual aspects; book clubs focus on spiritual matters; and movies and television shows abound with references to the spiritual. If nursing is to respond to the needs of the broader society within which it is situated, then it must address spirituality and the diversity of understandings of spirituality in society at large.
3. A focus on the spiritual is addressing the nature of what it means to be human. Spirituality is an integral part of being human and in fact, some would say that it is the essence of being human. This implies that all people have spiritual needs which need to be addressed in care.
4. Spirituality is a well-recognized concept in all known cultures. Culturally sensitive care is one of the hallmarks of good nursing care.
5. Spirituality and the religious expression of spirituality have been shown through research to have positive impacts on both health and illness. Health and illness are the ‘business’ of nursing; therefore, anything that contributes positively to health and illness would also be the ‘business’ of nursing.
6. Spirituality is a known protective factor that serves to foster resilience, one of the goals of nursing practice.
7. According to research, many clients desire for their health care professionals to address spiritual/religious concerns that they may have – as well as to support their spirituality/religiosity. If spiritual/religious needs are not met, then the client may experience spiritual distress.
8. Addressing the spiritual dimension of care is consistent with the nature, values, and goals of nursing. For example, nursing focuses on what strengthens and helps clients, seeks to provide holistic and comprehensive care, and values compassion, social justice, and recognition of the sacred, to name a few.
9. Many nurse theorists have spirituality as either a central concept in their theories/frameworks (for example, Watson and Neuman), or as a subconcept (for example, Rogers and Roy).
10. Nurses are in an ideal position to address spirituality with clients as they are the largest group of health care providers, have the most frequent contact with clients, and are involved with people at all points across the life span, including during their most vulnerable moments.
11. Nursing diagnostic taxonomies address spiritual distress as a recognized nursing diagnosis, for example, NANDA-I.
12. Various nursing education bodies endorse the importance of nursing education on the spiritual dimension of care, for example the American Association of Colleges of Nurses in the United States, and the Canadian Association of Schools of Nursing in Canada. Many nursing education programs include spirituality as a curriculum theme or, less frequently, include a course devoted to spirituality in nursing.
13. The nursing profession is generating an increasingly important body of knowledges on the relationship between spirituality/religion and health/illness with some proposing that it is the health care profession that is most advanced in this area. Nursing has contributed a number of spiritual assessment tools and intervention models that can be used in incorporating spirituality into practice.
14. Professional mandates require spirituality to be incorporated into client care, for example, the Joint Commission on Accreditation in the United States, the Oncology Nursing Society in Canada, and the World Health Organization globally.
15. Nursing standards and competencies dictate that spiritual assessment and care are essential to nursing practice, for example the Canadian Nurses Association’s Framework for the Practice of Registered Nurses in Canada and the American Nurses Association’s Nursing Scope and Standards of Practice.
As can be seen from this brief outline, there is ample rationale for the inclusion of spirituality into nursing practice. You are encouraged to read further on each of these rationales so as to more fully understand each reason for the inclusion of this important aspect of care. Understanding the evidence for the inclusion of spirituality into nursing practice is a critical first step in advocating for and developing this most important concept into care of clients.