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!

Wednesday, April 22, 2009

Spiritual Care Conference, Bergen, Norway

Most of this week I have been meeting with nurse leaders, academic, lecturers and students from across Europe as we once again explore what spiritual care is, and how we in practice care for the spiritual needs of our patients. In the UK this has recently become a hot topic with nurses suspended for praying with patients, and the National Secular Society has called for the NHS to stop funding all chaplaincy services.

And there is no doubt, as a recent Nursing Times survey has illustrated, that most nurses in Britain at least, find themselves poorly equipped to assess the spiritual needs of their patients and address the care needs that are subsequently identified. My father-in-law, a full time hospital chaplain, has commented on more than one occasion that most of the nurses in his hospital are actually embarrassed to even ask if a patient has a faith or belief system – even when they are also asking about bowel habits, diet and even questions about the patient's sexual health! Is religion and/or spirituality the last taboo? Have we found ourselves able to talk about sex, politics and now even death, but still "don't do God"?

One of the biggest question raised on our first day was simply how we translate research in to practice, how we train nurses to deliver effective spiritual care, and how we weave the spiritual in to all aspects of care rather than separating it out as something 'set apart'. Talking to one leading expert in the field who had just flown in from a Royal College of Nursing conference on spiritual care, it seems that there are voices emerging who are suggesting that nurses should play no role in any kind of spiritual care – and while the reasoning of the voices so far raised is clumsy and poorly thought through, there is no doubt that there will be opposition to restoring the spiritual as an aspect of nursing.

So, in bringing nurses the skills to address the spiritual needs of their patients, we have to start with nurses reflecting on their own spiritual nature and journey, whilst at the same time not forcing their beliefs on others. But that is only a start, because any practice of care must be based on good research and be held properly accountable within a professional framework, so it is more than just touchy feely stuff – it is qualitative and quantitative research, health policy and professional framework development, and training strategies. Yet, we have talked this over for two decades, and nurses still do not feel equipped in this area of practice.

Tomorrow we begin the conference proper, but out of today we are pulling together a network of researchers, practitioners and teachers who will work collaboratively on addressing some of these questions, and sharing more widely the experiences of those seeking to put good research in to good practice.

Tuesday, April 21, 2009

I just want a white coffee

Ordering a coffee – simple you might think, especially in the English speaking world. But even in France, Germany, Netherlands or Romania, I can just say une cafe or eine kaffe, and if I want milk in it, une cafe au lait, eine kaffe mit milch, danke. Easy.

So, when in New York last year I went in to a Starbucks and ordered a white coffee and just got a blank stare from the barista, I was somewhat taken aback. It turned out that what I should have asked for was an Americano with milk. OK, I thought, fair enough, different country, different terminology. Plus I reckon my Southeast England accent was also hard for a native Manhattanite to understand. No worries there then.

But today, when at London City Airport I asked for a white coffee and got a blank stare I knew the goal posts really had shifted. Granted, the guy serving me had a mild Dutch accent, but this was on my native turf! Surely he could understand what a 'white coffee' was?

Then it hit me. I was coming up against Globeish – a hybrid, commercial/business/tech dialect of English spoken around the globe. Shaped by global brands, global business schools, and global information technology, this is the dialect of choice for non-native English speakers and the emerging generation as they circumnavigate the globe (physically or virtually). But it is a different English to the arcane, southeast England dialect I know, where a white coffee is just coffee with milk. It is light years from the broad 'Estuary English' spoken by the kids in my neighbourhood (who neither know nor care about coffee), or to the mannered, professional English of the southeast's middle classes. This is an English where black coffee is an 'Americano' and white coffee a 'flat white', where we 'unpack' rather than explain, and 'google' rather than look up. It is the language of the inhabitants of Cyberia, a country I and my generation can only visit, but of which my children are fast becoming natives. Suddenly, I am old and on the outside.

As I travel the world, my once proud mastery of my mother tongue is called in to question – the English of students and business people, geeks and cybernauts of all cultures is increasingly not my English. I am the outsider, the semi literate who speaks the language as a foreigner, not as a native. This is a new world, linked through social networking sites, connected physically by identikit airports on the edges of urban sprawls, where the same coffee and fast food chains are to be found, identikit cloned, whether you are in Moscow, Seoul, London or Los Angeles. Maybe this is what the adjective ballardian describes; a bleak, uniform, post industrial landscape, full of dislocated and commercially dehumanised and desensitised clones who are no longer people but merely consumers? Is it in this world that Globeish has become the main means of communication?

Or is that just my take as a fearful cultural outsider looking at an undiscovered new country that the teenagers and children of today will call home, but to which I must always be at best, just a tourist? A country that has found its own language in Globeish? I think it was ever thus between the generations, divided by taste in music, fashion and use of language; only now the pace and depth of that change is accelerating and globalising. It is not a good thing, nor is it necessarily a bad thing. Ultimately it is a very human thing, and coming to terms with it is a way of coming to terms with one's own mortality. Time to hand on the baton to the new kids in town – my Generation X gives way to Generation Y, as they in turn will give way to the Millennium Kids – my children's generation. And with each new generation the language will grow and mutate, bending old words to new uses, creating new words for novel ideas and objects. Real horrorshow.

Meanwhile, I think it is time I went off and read some Shakespeare or Milton, or maybe some J G Ballard, just to reacquaint myself with my mother tongue in all its subtle, ancient glory. With a nice cup of white coffee, of course.

Monday, April 20, 2009

Farewell J G Ballard

Science Fiction is traditionally seen as the fiction of glittering futures and humanity conquering the "final frontier". Ballard, who died on Sunday, stood in the defiantly British tradition of SF that had no truck with such naive American over-optimism, and instead explored the darker side of where technological progress might take us. His most controversial novel, "Crash" explored a near future where human emotional connections were so weak, and where the obsessions of technology so strong, that the protagonists could only achieve sexual arousal through car crashes – techno fetishism and violence taken to a logical (and nightmarish) extreme.

He also explored ecological collapse in "The Drowned World" – echoing our modern fears about global warming long before they became part of popular consciousness. In fact, many of his short stories (with which I am personally more familiar) and novels explore unexpected catastrophes that threaten complacency or illustrate our over reliance on technology or social/political control.

In our surveillance dominated, risk averse, socially atomised and culturally stagnant post-industrial societies, he will stand for a long time as a secular literary prophet who confronted us with the uncomfortable realities of our chosen way of life, and the world is poorer for his passing. One can only hope that Ballard's death will renew popular interest in his great body of work, and inspire a new generation of science fiction prophets.