Friday, April 24, 2009

Spiritual Care Conference – Days 2 & 3

The second two days of the conference were primarily for student nurses and teachers. In a wide range of seminars, themes exploring spiritual care in mental health nursing, midwifery, palliative care and general nursing. There were about 22-23 nursing academics and teachers, and about forty to fifty students – mostly from Norway, but also several from Netherlands and Romania.

The first day's themes around how to train nurses in spiritual care were reiterated, but also looking at the issue of the ethics of spiritual care when nurse and patients have different belief systems. The case of Caroline Petrie, the nurse suspended (and later re-instated) after offering to pray for a patient was widely discussed (I was surprised to find how much coverage her story had garnered across Europe). Linda Ross and Wilf McSherry explored this theme together in a closing plenary session, and the debate that was generated could have gone on for the rest of the day!

It was clear from much of the discussion that one problem has been the teaching of spiritual care as a distinct module, rather than interweaving it with all other aspects of care – which reflects more how spiritual care is delivered in practice. From my own experience, it is usually while conducting a routine (though often intimate) task, such as a bed bath or dressing a wound, that a patient will ask a leading question, or make a statement that expresses a spiritual or existential concern. It is a much underrated skill in the art of nursing to read such comments and use sensitive questioning to explore further with the patient the underlying questions and needs the patient is expressing. While looking for the question behind the question is not a teachable skill - it is learnt and acquired through years of experience - the basic skills if observation and reflective questioning are readily taught. One concern I have is that the practice of nursing is moving away from the bedside and in to the office, such that it is the nursing assistant that does the "real" nursing rather than the Registered Nurse. That may explain why RNs in particular express so many anxieties about spiritual care.

Another theme that emerged was the need for evidence based practice in the field. We have long moved on from trying to define spiritual care – there are as many definitions as there are papers and text books, but we do now need to justify all areas of nursing practice in terms of outcomes – not an easy task for such a rarefied and unquantifiable area. I think nursing has less of a professional problem with fuzzy edges and ambiguity, but it is in health system that has focussed on the paradigm of the machine –with inputs, outputs, throughputs and processes at the fore, rather than the ragged complexity of human suffering and healing, which is the rality that nurses deal with routinely. But there is research being done on how best to care for people spiritually, and that is something we need to use as the basis for all training and practice, and to justify the role of spiritual care in nursing care (and indeed all healthcare).

Spiritual care in mental health is a new frontier – with research emerging only slowly. It is a contentious area, as some religious and existential issues will be exacerbated or expressed in mental illness.

Finally, the need for research and training to be multidisciplinary is also key – all aspects of the health service need to recognise human beings as complex social, psychological, relational, spiritual beings, rather than biological machines to be fed through a system. That is going to take more than a few seminars or conferences – it demands a fundamental, radical culture change in healthcare management, government health policy and applied medical science. So – the revolution starts here!

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