This essay will be exploring what spirituality is and why it should be incorporated in holistic care, how it is different from religion, and the role of a nurse in delivering spiritual care.
Narayanasamy (2004) suggests that “Spirituality is defined as the essence of being and it gives meaning and purpose to our existence.” Spirituality is a practice of seeking hope, meaning, and purpose of the life (Rogers and Wattis, 2014). Dictionaries (2018) describes religion as 'belief in ... especially god or gods.' Some people will view their faith as a source of spirituality; hence religion can be spiritual. However, individuals can be spiritual without being religious, or religious without being spiritual (Rogers and Wattis, 2014).
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When an individual faces crisis and illness, they may desire to discuss spiritual issues; nurses may be able to address any spiritual distress by being responsive and sensitive to these signals. It is also essential to consider how nurses can approach these spiritual issues if the patients do not raise them directly. It is important to address the patient's spiritual need to provide holistic care (Rogers and Wattis, 2014). Holistic care is a care that considers the 'whole person' and not merely the condition or illness the person has. Holistic care recognises the uniqueness of the individual, personality and the individuality in them (Brooker and Waugh, 2013). Unquestionably an individual's physical health is related to mental health and their soul, in other words, body, mind, and soul are interlinked. Wright (2005) states “Spirituality and health are linked to each other, inseparable companions in the dance of joy and sadness, health and illness, birth and death.”
Nurses require a degree of cultural competency and an ability to distinguish and recognise patient's spiritual issues. Nurses must be aware of what spirituality means to the particular patient and respect the patients' choices, and nurses should not impose their own values and beliefs upon patients (Williams, 2016).
Although spiritual care is recognised today, it is often neglected as some nurse view religious and spiritual needs as a private matter, lack knowledge about it, and view these needs as a family and pastoral responsibility (Williams, 2016). To deliver holistic care, nurses need to address the patient's spiritual needs along with other biopsychosocial needs. Spiritual care would include nurses recognising patient's spiritual practice/restriction, identifying who can help patients with spiritual support, providing opportunity to express their spiritual needs and concerns, determine spiritual objects that have meaning to the patients, provide opportunity for spiritual guidance with respect for privacy, and encourage contact with a spiritual counsellor in times of crisis (Williams, 2016). Nurses could use models like ASSET (Narayanasamy 2006) to exploit spirituality and spiritual care. According to ASSET model, nurses should have self-awareness of their own beliefs and values which should not influence the way they deliver care, what spirituality means to them and what is spiritual nursing (Ellis and Narayanasamy, 2009).
Integrating spirituality into the practice leads to more holistic care, increases nurse-patient therapeutic relationship and improvement in recovery rate. The meaning to spirituality can differ from one person to another. For some people, religion can be a source for their spirituality, but that does not mean one has to be religious to be spiritual or spiritual to be religious. Spirituality may mean more to an individual during the time of crisis; it may only be the foundation of hope for them or a form of practice where they can submerge their sorrows and griefs.
Cultural competence in Nursing
This essay shall be looking into the cultural impact that nurses should be aware of when delivering care, what culture means, and what cultural competence is.
Leininger (1991) defines culture as the 'learned, shared and transmitted values, beliefs, norms, and lifeways of a particular group that guides their thinking, decisions, and actions in patterned ways.' (Burnard and Gill, 2013). It is important to remember that the component of culture is always changing with time and evolving. It consists of a family or society tradition, beliefs, values, rituals, and norms that have been passed down from many generations (Brooker and Waugh, 2013). Culture is an umbrella term used for a collection of different types of culture. There are various types of cultures such as individual, group, society, work and so on. When an individual enters an unfamiliar culture and realises the difference suddenly or gradually, this is known as culture shock (Burnard and Gill, 2013).
Nurses are expected to illustrate effective cross-cultural communication and deliver culturally competent nursing care to people from diverse backgrounds, cultures, and ethnicity (Andres and Boyle, 2016). Care given to the patient by the nurse should be person-centred care (McCormack and McCance, 2017). One of the principles of PCC is to provide holistic care and secondly to work with the patient's beliefs and values (McCormack and McCance, 2017). In some cultures, and religion, modesty is important and so patients would not be happy wearing revealing hospital gowns, or to be seen by opposite-sex healthcare workers. Another instance would be, patient refusing medical interventions, for example, blood transfusion or tissue transplant not being permitted by Jehovah's witnesses. To a nurse, this may come across as an unwise decision or patient being difficult, but nurses need to respect that choice made by the patient to maintain patient's autonomy (Brooker and Waugh, 2013).
To deliver holistic care, nurses must be sensitive to patients' and patients' family’s cultural expectations, with no stereotype assumptions. Nurses should have basic cultural awareness. Nurses need to gain information on their patient's culture, show empathy through verbal and non-verbal communication skills, nurses should listen with open-mindedness and be non-judgemental, and show a willingness to learn (Burnard and Gill, 2013). Cultural competence is a process of acquiring specific knowledge of how to respond to the demands of cultural diversity, awareness, and sensitivity. It is an action portrayal of behaviours that help to minimise or eliminate the differences and barriers that often occur when people of diverse cultures interact and communicate (Schim and Doorenbos, 2010). This process includes five components: cultural awareness (self-examination of one's background, prejudices, and assumption about others), cultural knowledge (obtaining sufficient knowledge of diverse groups), cultural skills (recognising factors influencing treatments and care of patients), cultural encounters (engaging in cross-cultural interactions) and cultural desire (accepting the role of a learner with open mind, accepting cultural differences and building on similarities) (Potters., et al, 2013).
People should be treated equally regardless of what their culture is, which may consist of beliefs, values, and norms that may be contrary to that of a nurse. Nurses must be able to deliver culturally competent care to the patients especially in today’s U.K.'s diverse community today.
Understanding of the nurse’s role in safeguarding
Safeguarding is a very complex topic; it can relate to children, adults or anyone with protected characteristics such as gender reassignment, disability, pregnancy, and maternity, learning disability, belief or non-belief, sex, sexual orientation or age. Therefore, this essay shall be focusing on adults safeguarding; it shall look into what makes adult vulnerable, safeguarding referrals and how safeguarding protects them.
Department of Health (2014) defines safeguarding as protecting individuals' right to live a safe life, free from abuse and neglect (Griffith, 2015). Harm and abuse include behaviours that are defined as harassment under the Equalities Act 2010. It is also evident that people with particular protected characteristics are more susceptible to harm, abuse and neglect (DH, 2014).
According to the Care Act (2014), safeguarding applies if a local authority has a reasonable cause to suspect that an individual has needs of care and support (whether they are receiving care or not), and as a result of those needs is unable to protect him/herself against the abuse or neglect or the risk of it.
The Care Act (2014) focuses more on different forms of abuse rather than categorising people as vulnerable. The different types of abuse outlined in the Act are physical abuse, domestic violence/abuse, sexual abuse, psychological/emotional abuse, modern slavery (Human trafficking, forced labour), discriminatory abuse, organisation or institutional abuse, neglect or act of omission and self-neglect (Dalphinis, 2016).
Nurses role also include safeguarding their patients. Nurses need to abide by all the domains in 'The Code' (2015); and according to the code, nurses need to preserve the safety of their patients (The Code, 2015). Nurses have a duty of care to safeguard vulnerable adults from abuse and neglect. Safeguarding is important as it promotes human right and equality through sets of safeguarding principles, which are empowerment, protection, prevention, proportionality, partnership, and accountability (DH, 2014). An individual who is capable of giving their consent has the right to refuse treatment, and this must be respected. According to one of the principles of Mental Capacity Act (MCA) (2005), nurses must assume that an individual has capacity unless proven they lack capacity. Secondly, nurses should take all practicle steps to meet their patient's needs and wishes. The third principle of safeguarding is that patients are allowed to make their own decision; even if it may seem unwise to the nurses. Another principle is that nurses must act in the patient's best interest if the patient lacks capacity meaning that the patient is unable to understand and retain information, make a decision, and weigh the information. The last principle is to ensure the least restrictive option is taken (Nhs, 2017).
Safeguarding concerns should be raised where any form of abuse is reported or suspected. It is nurse’s role to raise the concern, take timely and appropriate actions to investigate further and refer the concern on to an appropriate body such as safeguarding leads, Care Quality Commission or local authority (Griffith, 2015).
Nurses need to be aware not just of people who are vulnerable, but they should be able to recognise different forms of abuse. It is nurses' duty of care to safeguard patients and colleagues as it is a human right of everyone regardless of protected characteristics that they can live safely, free from abuse and neglect.
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