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!

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.

Spiritual Care Conference - Malta October 2007

Addressing the spiritual in day-to-day care of people, whether as a nurse or other health professionally, is becoming nationally and globally something of cause de jour. Conference, books, academic papers abound, but I think one of the things that is rapidly becoming apparent is that there is no uniformity of agreement on what spirituality and spiritual care actually are.

Wilf McSherry of the University of Hull at the conference I recently attended in Malta (‘Spirituality: The Human Dimension In Care’) pointed out that while nurses and other health professionals increasingly understand that spiritual care is about helping a patient on their journey through illness - addressing the needs for meaning in the experience, finding resources to cope with change and suffering and finding some sense of the transcendent in the whole experience - most patients and their relatives think by spiritual we mean "religious" and so say it is not for them - despite then talking about these wider spiritual issues as being relevant (but not using "spiritual" language to do so). Spiritual care does not necessarily mean religious care (although that is a part of it).

It is interesting that most of the research being done in this field in Europe at least (and the USA and Canada) seems to be undertaken by Christians. There is some New Age stuff out there as well, but not much else. Now, as a Christian myself I am heartened by the work my fellow believers have put in to the topic - and in a non-partisan manner - they are addressing the concept of "spiritual care" in its widest sense (more so, I venture than some of the more wacky New Age approaches, which seem hopelessly vague and wishy-washy to me). No, I am more concerned that the humanist scholars are not out there as well, nor are there humanist chaplains. Surely we are a secular culture here in the West, and that culture should have found itself a secular spiritual expression. However, it seems that in a secular culture, the spiritual is still a taboo area, and still seen as the provenance of the religious. Maybe that should not surprise us.

And maybe that is a reflection of our culture's spiritual poverty. I noticed that the Maltese remain deeply religious (Roman Catholic), and committed to spiritual care - the Cappuchin monks provide over twenty Chaplains to the health services of Malta and Gozo. My father-in-law manages with three part time chaplains and a small number of volunteers for a major urban hospital serving a population of a quarter of million plus. In Malta, with around 400,000 people the one major hospital has sixteen full time chaplains. They have also built in their brand new hospital a chapel physically (and very symbolically) at the centre of the hospital. (see below)

In a culture so steeped in the spiritual this makes sense - the Christian faith creates the framework for addressing the core spiritual needs of the individual. I wonder what that framework now is here in the UK? The answer seems to be so atomised and individualised that it must be a nightmare to approach spiritual care outside of shared framework of one faith or another.

But I digress. The conference, while somewhat didactic to my tastes (my bum got very numb from sitting for so long), still was very engaging. Perhaps the main thing I took away from it was that you cannot teach nurses to be good at caring for the spiritual needs of their patients. They need to "get it" - they need to "catch it", but they cannot really be taught it. Yes, you can teach basic skills and awareness, but to understands the spiritual needs of a patient takes a certain imagination and empathy, and certain willingness to step outside of modern imposed professional boundaries to recognise the patient as a person (as I learnt earlier today, in Uganda they now use the term "friend" instead). At its core, it takes an awareness of the spritual side of one's own nature to be able to grasp the spiritual needs of one's own client - and in a secular culture, there is little language and shared framework for most people to be really be able to do this.

Of course, this is nothing new - caring for the spiritual is what nurses have always done. The roots of nursing, in Europe at least, are in the Christian monastic orders where spiritual care came as second nature - it was part of the warp and weft of their very existence. Other faiths have similar traditions of care, even humanism is rooted in such notions.

Sadly, here in the UK at least, this ethos seems to have been lost in our professional and wider culture in the 21st century.