5.5 The spiritual trigger response
5.6.2 Principles of spiritual care
I. Spiritual Care should be directed at the unique spiritual expression of the client and a nurse.
Spiritual caring means that the nursing activities arc directed towards meeting the patient's unique spiritual experiences by matching them with the unique spiritual expressions of the nurse. Because of the particularity inherent in spiritual experiences, nurses ought to give spiritual care that is directed towards the particular person's spiritual hunger. This type of care is based upon a trusting relationship between a nurse and a patient, which is built on compassion of the nurse and acceptance of the patient as a unique being. Meeting the unique spiritual expressions of the patient will take into consideration the patient's culture, religious beliefs, nationality. racial background and age. When the unique spiritual expressions of the patient are acknowledged and attended to, the patient, the family and the significant others will begin to move towards a more positive pole of the spiritual health continuum.
2. Spiritual Care is embedded in the unique roles of accompanying, helping, presencing, valuing and interceding which are driven by compassion for human suffering and pain. The care that is driven by compassion is characterized by sympathy, empathy, unconditional love and sensitivity to human pain and suffering. Sympathy expresses sorrow for the other person. In short sympathy
says, "} feel sorry for you", on the other hand empathy gets inside the feelings and shows that the feelings are acceptable and understandable as real and that there is a way out of them. Empathy identifies with the feelings of the other and accepts them as real and accepts the person as genuine in the process. Empathy comJllunicates acceptance of feelings while sympathy communicates recognition of feelings (Buchanan, 1985).
Compassion is aconcepl broader than both sympathy and empathy combined. It involves suffering with the person. Compassion says "I'm sorry, I recognize your feelings, I understand them, I accept them as real, I ean identify with them and I will do something to help you feel better"
(Folkenbcrg, 1998). A compassionate nurse walks a second mile to find whatever will make the patient feel better. Compassion is a concept closely related to unconditional love. Expressing compassion is a way of expressing unconditional love and acceptance of a person as a unique being.
Unconditional love can only be equated to God's love for humans. This type of love knows no boundaries, it reaches out to all creatures great and small. It is not limited by race, culture, creed or nation. Unconditional love is the very nature of God. It embraces every duty we have to God and to those around us. I f humans love God and other fellow humans, they will do nothing that will harm or hurt others. The human being's natural tendency is to love on condition that a person meets certain human criteria for deserving love irrespective of the obligations incumbent upon them in relation to God and other fellow human beings. When patient care is based upon the principle of compassion and unconditional love, patients will sense this love and they will feel acceptable and loved. The love they experience will flow from the nurses to patients and their families.
3. Spiritual Care should be a communal activity. Communal involvement is the core of traditional African thinking about relationships between and among people. Communal refers to community involvement and participation in one another's affairs. The nurse, patient, family, significant others and the community at large should be involved in providing spiritual care. This communal involvement is inherent in the principle of "ubuntu"which is the premise of communal involvement. African proverb says "umntu ngumntu ngabantu" which means a person is a person
because of others or "J am because we are and we are because you are". This identifies a person with the community and on thc other hand idcntifies thc community with the people. Though the concept of"ubuntu" is an African terminology which cannot be easily translated to the Western language, its principles can be utilized in every community including the Western and the Eastern nations. With the increased AIDS epidemics and the need for community involvement in the care of patients and families, the principle of 'Ubuntu" will bring the solution to the crisis of home based care which has now become a trend in patient care. The capacity of care is every community member's responsibi I i ty.
Based upon the principle of"ubunnl" spiritual care should include all interested parties. That is the patient, his or her own family and the significant others. Human beings are also social beings, therefore their spirituality cannot and should not be separated from their social life. Ubuntu recognizes this social aspect of being human, and puts an emphasis on the role played by other human beings in the development of a person as a whole.
5.6.3 Factors innuencine spiritual care
Spiritual care is greatly influenced by the nurse and the patient's religious beliefs, cultural diversity, the patient's ability to express the spiritual needs and the nurse's ability to recognize the needs and be able to intervene appropriately.
5.6.3.1 The influence of religious beliefs
Religious beliefs refer to what the person believes and to the way the person expresses his or her beliefs as expressed in a organized and recognized system. When a person's belief is founded upon a credible authority and a trustworthy being, then a person will be able to find security in that being during the times of uncertainties of life. Religious beliefs are therefore springs that both nurses and patients can draw from to quench the spiritual thirst. It becomes important therefore for nurses to understand the patient's religious beliefs in order to intervene appropriately.
Religious beliefs provide a person with an interpretation of the situation. What illness and death means to people depend upon what they learn from their religious beliefs. If the person's religious
belief gives an impression that illness and death arc a punishment from God, then anger directed
to God will be prolonged and the nurse will have to work with the patient to help him or her understand the God of love.
5.6.3.2 The influence of cultural diversity on spiritual care
Cultural diversity refers to the differences in the way oflife, it includes differcnces in nonns and values, in customs and traditional practices, in the way ofworshiping God and in ways of relating to God as the Supreme being and in ways of relating to other human beings. How people relate to one another tends to influence how they relate to God. Cultural beliefs and practices tend to influence the person's expression of spirituality and therefore the delivery of spiritual care. Often the nurse and the patient may be from different cultural backgrounds and in that situation the patient's spiritual needs may not be understood and therefore not fulfilled. It is therefore very vital for a nurse to understand different cultures and to understand how patients express their spirituality within their cultural context.
5.6.3.3 Recognizing spiritual needs
The nurses' ability 10 recognize spiritual needs is also influenced by the nurses' exposure to different cultures, religious beliefs and to his or her own professional spiritual health. The ability to recognize spiritual expressions and to be able to give spiritual assistance also depends upon the nurses' level of spiritual education, intuitive abilities and personal experience with patients. The more experienced nurses were, the more they were able to recognize spiritual needs and there more they were able to provide spiritual intervention. Providing spiritual care was also influenced by the nurses' sensitivity to patient needs and by her compassionate nature. Sensitivity to patient's needs and compassion for human suffering and pain are skills that nurses need to learn. These skills do not come naturally, they are to be learned.
5.7 Nurse's Spiritual Care Rol es
These are five major roles ora nurse that have been identified in this theoretical framework of spiritual caring. These roles are interrelated, and mutually inclusive. The activities directed towards meeting these roles may also be similar. These roles are cited as (I) Accompanying role, (2) Helping role, (3) Presencing role, (4) Valuing role, (5) Intercessory role.
5.7.1 The ac('ompanvine role of a nurse
The accompanying role of a nurse is the ability of a nurse to identify the spiritual needs of a patient and assess the patient's readiness for intervention and to walk with the patient from where the patient is to where the patient wants to be. Patients need company as they walk through the rough roads oflifc, pain, suffering and death. Walking with the patient gives an opportunity for a nurse to assess other spiritual needs of the patient. While walking with the patient the nurse also acts as a facilitator of patient 's quests for bonding with the transcendent. While accompanying the patient, the nurse also gives guidance to the patient and his or her family. The nurse acts as a mentor for the patient and the family and also remembering that the nurse would not lead them faster than they would follow. When the nurse accompanies a patient, he or she walks with the patient where the patient leads not where the nurse wants to be.
When accompanying the patient and family, the nurse also educates and gives support to both the patient and his or her family. The company that a nurse give to the patient relieve spiritual fears and anxieties associated with illness and death. It is therefore hypothesized that accompanying a patient in the rough road of illness and death may increase his or her sense of self worth. The patient begins to perceive himself or herselfas valuable. The principle of communal responsibility is clearly revealed in the accompanying role of a nurse. A person is a person because of others.
Therefore others are needed throughout the life cycle.
5.7.2 The Hclpin~ Role of a Nurse
The helping role ofa nurse refers to the nurses ability to give whatever assistance the patient and his or her family needs. The nurse may not always be able to give the help needed per se, but she or he may find another person to provide that particular need. The forms of help mentioned as part of the helping role of a nurse include giving comfort, encouraging, reassuring, advocating for the patient and family collaborating and referring appropriately.
5.7.3 Presencin~ Role of a Nurse
The presencing role of a nurse refers to the nurse's ability to be readily available to the patient and his or her family by being physically present by the patient's bedside. Being with the patient and his or her own family in their pain and suffering and in death is an indispensable role of a nurse. Presencing involves being physically and emotionally with the patient and his or her family.
Just being there next to the paticnt's bed is onc way of expressing one's compassion for human pain and suffering. While being there, the nurse is engaged in active listening to whatever the patient or family want to say. Active listening involves being every perceptive of statements that the patient, family make, listening with sensitivity and listening between the lines in order to catch and note the patient and the family's concerns
5.7.4 The vallJin~ role of a nurse
The value is the worth assigned to something or someone, therefore, the valuing role of a nurse refers to the nurse's ability to care for the patient as a unique and a precious being bearing human dignity (Taylor, 1986). The link with God in every human being is what determines human value.
When valuing a person, a nurse will accept the patient and respect the person as a human being.
A nurse gives value to the patient and respect his or her dignity including the patient's choices of relationships, life style, beliefs and values.
When a nurse cares for the patient as a valuable being, that increases a patient's sense of self worth and the ability to cope with illness and with death. Valuing a patient maximizes patient's
control and reduces nurses' control over the situation. The patient bccome in charge of his or her own illness and prognoses. Valuing the patient is recognizing a patient as a person and in terms of "Ubuntu". Umuntu is the concept unique to the African languages it reflects the communal responsibility of onc person to another. "Umntu ngu mntu ngabantu" (I am because you are, you are because we are) "Ubuntu" is expressed in human relationships through expressions oflove and compassion for one another (Tlale, 1999).
5.7.4.1 Love and Compassion as cxpr-cssions of human value
These two concepts are so closely linked that none would exist without the other. A loving person is a compassionate person and visa-versa .. Love compels a person to do something for the other without expecting a reward in return. This is referred to as the unconditional love. The concept of compassion comes from the Latin word which means "to suffer with". Compassion challenges a nurse to go where it huns, to enter where there is pain, to share brokenness, lear and anguish, to cry with those in misery, to mourn with those who mourn, to identify with the weak, the vulnerable and the powerless. This form of compassion is more than being kind and respectful.
Compassion is not a spontaneous natural feeling. It requires a genuine conversion of the mind and a conscious effon on the part oflhe nurse. What comes natural to humans is to have love and compassion to those we think they are deserving our love and compassion. This type of compassion is not compassion at all. Ifwe love the lovable and give compassion to the deserving, we are simple rewarding those for their "good" behavior.
Folkenberg,(1995) states that "we often prefer to be selective with our compassion. We have compassion for people with AIDS- as long as they got the disease from blood transfusion. We have compassion for people whose houses burn down as long as they did not start the fire by smoking in bed. We have compassion for people who've lost their jobs -as long as it wasn't their fault". He concludes by saying "we need a personal relationship with God to understand and practice compassion."The compassion God gives can so fill our lives that it will spill over to all around us" (Folkenberg, 1995). Compassion goes beyond sympathy, to include empathy,
sensitivity to human; suffering, non-condemning love, willingness to walk as a second mile and accepting and giving onc's self.