Spirituality: common mind, expression of each one
Spirituality and Health Care: Reflections and Practices in the Global Village Hospital
Spirituality is a sunny terrain that knows no geography or boundaries, barren in its unambiguous and universal definition, a perennial essay zone for the subjectivity of human needs during one’s life cycle. The “here” and the “where” the person is to be considered as the “ABC” of the relationship with the spiritual dimension of man, especially in the face of the cultural connotation it represents for each of us.
Spirituality is always “something more” than what can already be known, in that the person manifests a thousand faces of himself, especially in the face of certain dilemmas of his existence: life and living it, until death.
Illness, as man’s first limit, seems to discover and exalt this dimension, so man shows himself and often manifests words, gestures and behaviors that speak of evil, but also of its possible cures.
Spirituality is recognized as a valuable resource for all those who are experiencing a critical period in their lives; it is no coincidence that there is a close and positive correlation between “spiritual dimension” and “health.”
Since an individual’s spirituality is deeply influenced by his or her personal, cultural, social and religious history, it is difficult to find a universally accepted definition, as it is uniquely individual and subjectively defined.
However, spirituality can be succinctly summarized as that which gives meaning, purpose and direction to our living; the set of beliefs and values by which we “organize” our lives.
Considering that today’s Italy, and thus its health care, have become a global village full of “souls and colors,” especially as a result of migration flows, the needs expressed by assisted persons can be the most varied and “unexpected.” In Italy, there are many people from countries such as Romania (about 1 million), Morocco (513 thousand), Albania (498 thousand), China (305 thousand) and Ukraine (225 thousand).
The results of the research on the state of religions in Italy, conducted in 2013 by CESNUR (Center for the Study of New Religions), showed that our country is home to more than 800 religious and spiritual minorities (understood as religions other than Catholic), and that among Italian citizens, Protestants (30.7 percent), Buddhists (9.5 percent) and Jehovah’s Witnesses (9.3 percent) prevail; among immigrants: Muslims (42.3 percent), Orthodox (40.2 percent) and Protestants (6.6 percent).
Generally, a person’s spiritual dimension emerges most intensely and urgently when the “system” to which he or she has relied seems no longer able to meet his or her needs. This is also explicated in the “spirituality” articles in the literature that precisely deal with this dimension especially in comparison with the field of Palliative Care. It is at these delicate moments in life that the individual, sometimes pervaded by those feelings of fear, anger, tension and bewilderment, begins to look ahead in search of meaning, purpose and interpretation of his or her existence, asking questions about the “whys” and “wherefores” of the onset of illness.
Although a person’s spirituality emerges particularly in care-intensive settings, this dimension must be assessed on a case-by-case basis and in each person; it is, in fact, crucial to pay attention to the spirituality of the so-called “frail ill” (minors, women who become ill during pregnancy or who decide to terminate it, patients with psychiatric illnesses or those with an inauspicious prognosis).
In this regard, starting last December, a preliminary study was conducted in some wards of the Careggi University Hospital and Florence Health Authority in order to detect the presence of spirituality in care practices.
The objective of the study was to ascertain the extent to which nurse practitioners were aware of the existence of a spiritual dimension and whether it was contemplated in their daily practice.
Through the compilation of a multidimensional observation grid, it was investigated “how” and “how much” in the daily used clinical records (an indispensable tool for a deeper knowledge of the patient) the spiritual aspect is considered. A reading of the “clinical diaries” in the charts revealed rather curious terms, noted by the practitioners themselves or directly reported by patients. There are those who ask to “be left alone,” those who, on the other hand, state that “loneliness kills” and that they do not want to be alone in the room; those who ask questions, such as “but will I get well or will I die here?” or those who are serene about their state of illness because of their religious beliefs; those who ask to be able to go home to be with their family.
The nurses then also filled out a semi-structured questionnaire, divided into two sections, the first of which was devoted to the nurse and his or her knowledge about spirituality, and the second focused on the interaction operator and patient’s spiritual needs.
A maximum proportion of subjects (83%) report knowing the difference between religion and spirituality, and the majority of practitioners (88%) attach distinct importance to this dimension as a dimension proper to nursing, explaining the reasons why the spiritual dimension cannot and should not be neglected. Among the most interesting “why” we note that “spirituality defines the essence of each person,” “spirituality helps in the healing process and facilitates a good dying.”
What kicked the research into high gear was the question, “if you imagined being the patient.”
The spiritual dimension, in fact, belongs to everyone, caregiver and care recipient, and a knowledge of one’s spirituality on the part of the caregiver himself or herself turns out to be the “prelude” to the provision of careful spiritual care. Some operators spoke of themselves in the face of illness (I would like my mother near), others of the theme of “hope,” still others of their own “way of being” in the face of pain that would require a “special” consideration of the existential condition of suffering at such a fragile and delicate time in a person’s life. Some spoke of “loneliness,” others of “presence and support”; in any case, human principles that should not “season” care (said by the operators themselves), but be its motivating soul.
The operators also reported how spirituality frequently affects their daily work (52 percent of the subjects responded that they “often” find themselves having to respond to spiritual needs) and it is as if three dimensions emerged among the spirituality needs “encountered.” Among them, one frankly religious (extreme unction, accompaniment to death, participation in mass), one more closely related to dignity (covering one’s body, respecting certain cultural traditions of one’s country of origin), and one properly inherent to one of the primary elements in human life: self-determination.
A further indicator collected is that only 35 percent of nurses say their team is able to respond to patients’ requests for spiritual needs. What they feel they are “good enough at” is listening to people’s spirituality.
While it is true that, in general, a certain “flair” is required on the part of the caregivers themselves to succeed in this, the “training” component, the “updating” and the presence of reference procedures and protocols to be used on the ward (present only in the hospice SOD) also have their weight.
There is often a tendency to think things big when, instead, the answer lies in small simple gestures and attitudes, such as encouraging stories, fostering rituals if requested, being open to people’s questions. A qualitative study conducted in Thailand entitled “Spiritual care provided by Thai nurses in intensive care units,” revealed five themes that Thai nurses consider important in ensuring optimal spiritual care: providing psychological support, facilitating the performance of religious rituals and respecting cultural beliefs, and communicating with patients and their families.
Let us now try, at least for a moment, to expand our reflection on the “human-human relationship,” understood as a “someone” (practitioner) who takes care of and goes for a time to vicariate the “life” of someone else (patient).
The U.S. psychologist Maslow (1954), with his “hierarchy of human needs,” even put us on the “suspicion” that the need for spirituality may be among the primary human needs, as thinking well about the considerations put forward by the operators, in fact, dying well or living decently in the hospital stay, “perhaps” should not then be considered as a human trait so distant from eating or drinking.
There are many “ways” to deal with care in all its complexity, and to this end, it is necessary to actively sensitize operators to these needs through institutional training courses, but we can also do so ourselves right away, through the enhancement of three of our five sense organs: the “sight,” “hearing,” and “touch,” considered as a whole the indices of “being with” the person.
Today, physical contact still seems to “scare” some practitioners, as if it meant crossing into the person’s intimacy and understanding, thus, what he or she is really feeling. Sometimes it is the same fear of not being able to maintain that “meter” of detachment between our soul and that of the patient that prevents us from a simple “hand touch.”
It is amazing to think how much a caress is a multipurpose, eloquent and expressive elementary gesture, capable of conveying strength, but also courage and emotional commonality.
Bibliography
- Campanello L., Sala G., The Spiritual and Religious Dimension at the End of Life, Chapter 7 in M. Costantini, C. Borreani, S. Gubrich (eds.), Improving the Quality of End-of-Life Care – A Possible and Necessary Change, Erickson, Gardolo (TN), 2008.
- IDOS Study and Research Center, Immigration Statistical Dossier 2013, Rome, 2013.
- Ellis H. K., Narayanasamy A., An investigation into the role of spirituality in nursing, British Journal of Nursing, 2009, 18(14): pp. 886-890.
- Introvigne M. and Zoccatelli P. (under the direction of), Encyclopedia of religions in Italy, Elledici, Turin 2013.
- Lundberg P. C., Kerdonfag P., Spiritual care provided by Thai nurses in intensive care units, Journal of Clinical Nursing 19, 2010.
- Puchalski, C., Spirituality in health: The role of spirituality in critical care, Critical Care Clinics 20, 2004: pp. 487-504.
- Sartori P., Spirituality 1: should spiritual and religious beliefs be part of patient care?, Nursing Times, 2010, July 19.
Iacopo Lanini
FILE Italian Foundation of Leniterapia
Department of Health Sciences – University of Florence
Sara Cheloni
Bachelor of Science in Nursing – University of Florence