Wednesday, 10 June 2009 10:00 Last Updated on Friday, 02 October 2009 11:18
April 22-24 2009, Haraldplass Deaconess University, Bergen, Norway- Presentations and material from the conference - thursday 23rd
- Presentations and material from the conference - friday 24th
One of the biggest question raised in the pre-conference 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 in London 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 against has often been clumsy and poorly thought through, there is no doubt that there will be opposition from some quarters to restoring the spiritual as an aspect of nursing. However, there is also an increasing awareness in even very secular health systems that there is a spiritual dimension to human beings that must be addressed in all aspects of healthcare.
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’ – effective spiritual care also requires qualitative and quantitative research, the weaving of spiritual needs into health policy, professional framework development and training strategies, and so forth. Frustratingly, we have talked this over for two decades, and nurses still do not feel equipped in this area of practice.
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 28 nursing academics and teachers, and about sixty students – mostly from Norway, but also several from The 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 British 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). Dr Linda Ross of the University of Glamorgan and Prof. Wilf McSherry of the University of Stafford 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 also reflects how spiritual care is often delivered in practice. From my own experience, it is usually while conducting a routine (though often intimate) task, such as 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 that they are expressing. While looking for the question behind the question is not a teachable skill (it is 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 seems to be moving away from the bedside and in to the office, so 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 of practice. I think nursing has less of a professional problem with fuzzy edges and ambiguity than medicine, but we nurses function in a health system that increasingly is modelled on the paradigm of the machine –with inputs, outputs, throughputs and processes at the fore, rather than the ragged complexity of human suffering, the struggle for meaning and healing, which is the reality that nurses deal with routinely. So where 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 only expressed in mental illness. There were some interesting seminars addressing this subject, particularly from Sweden. Other interesting topics included the spirituality of child birth and spiritual care in palliative nursing.
This was an enjoyable and challenging conference, and we hope to see its success repeated in at te 5th International Students’ Spiritual Care Conference in Zwolle, The Netherlands in 2011.