In this paper Nursing as a Caring Spirituality will
be explored within the context of nursing as a caring profession.
The importance of the maintenance of hope in nursing care
will be highlighted. Through identifying and providing spiritual
caring both the nurse and the person in need of care will
benefit and grow.
Nursing and Caring
Health professionals, in particular nurses,
have paid much attention in recent times to the concept of
caring, which is a central theme to the practice of nursing.
Nurses must claim ownership of caring in order to define their
professional discipline. Milton Mayeroff in his writings,
On Caring (1971), outlined eight major ingredients
of caring. Two of these ingredients are Hope and Courage.
Nurses in their caring facilitate hope in the people for whom
they care and are the personal witnesses of enormous courage
as people live through their health/illness experiences. Nurses
also display notable courage in providing exquisite care in
difficult and challenging situations. The experience of caring
is not formula based. The essence of caring provides a deep
reservoir for clinical nursing research in our search for
truth - truth which articulates the decision making process
for the delivery of patient care. There is a paramount need
for meaningful communication in order to pursue such truth.
That is, communication which exchanges each person’s experience
The Meaning of Hope in Nursing
In an Australian nursing text, Spirituality, The Heart
of Nursing (Ronaldson, 1997), one of the themes which
emerges from the writings of contributing authors is the need
for nurses to foster and maintain hope for individuals in
need of nursing care. Nurses are often witness to people’s
personal experience of spirituality and their endeavours to
understand the meaning and worth of their life particularly
when confronted by an incurable condition or chronic illness.
Spirituality, as defined by Elizabeth McKinlay (1992) is ‘that
which lies at the core of each person’s being, an essential
dimension which brings meaning to life. It is acknowledged
that spirituality is not constituted only of religious practices,
but must be understood more broadly, as relationship with
God, however God is perceived by the person, and in relationship
with other people’ (cited in Ronaldson, 1997, p.101).
Susan Gaskins' 1995 research, The Meaning
of Hope: Implications for Nursing Practice and Research,
gives us some insight into the themes which define hope for
people who have a chronic illness. Three of the most common
themes defining hope were spirituality, relationships with
others, and having one’s health.
While acknowledging that hope is difficult
to define and which is context based, Carol Farran et al.
(1992), in their nursing paper Clinical Assessment of Hope,
state that hope is ‘an expectation about attaining some desired
goal in the future, a necessary condition for action, a subjective
state that can influence realities to come, and a knowledge
that as human beings we can somehow manage our internal and
external realities’ (p. 130). For this research on the clinical
assessment of hope they identify four central attributes of
an acronym of hope: H-health, O-others, P-purpose, and E-engaging
Hope and Health
Hope is opposed by despair for people who are ill, but also
for well individuals. A person’s sense of hope is challenged
in everyday living and it is quite an obvious dimension when
confronted by challenges to health. Hope is related to people’s
desire to achieve a goal in life. As nursing professionals
we are regular witness to statements of hope. You hear patients
say, "I hope to feel well again", "I hope to walk again" and
"I hope to live until Christmas". Within the perspective of
health and well-being hope is a fragile reality.
Nursing research is broadly based on issues
surrounding health. Our hope is to optimise each person’s
health and their innate resources. We can benefit investigations
of health status by framing such research on patient and carer
concepts and their understandings of hope and of health.
Hope and Others
As humans are a social being, our hopes and expectations of
others and of ourselves are inextricably interwoven. As nursing
professionals we must assess other’s context of hope and its
value in their lives. Nurses are in a strategic position to
foster and maintain hope in individuals. To be adequate here
we must also recognise our own sense of hope. ‘Hope in its
mature form becomes a sense of certainty about the coherent
nature of human life and an acceptance of one’s lifestyle
as worthwhile’ (Farran et al., 1992, p.134.)
Central to hope and others is the establishment
of a trusting relationship. Nurses must endeavour to pursue
trusting relationships with those for whom they care and their
significant others, and also with the wider community. Society
expects and deserves that they can place their trust in nursing
professionals. Importantly, nursing research of a high quality
needs to be conducted, and where appropriate, be focused on
client outcomes and not just our aims.
Hope and Purpose
Purpose involves a person’s concept of raison d’etre - their
reason for being, their spiritual being. A person’s sense
of spirituality must be identified and respected. In everyday
life, and particularly in ill health, spirituality is explored
by individuals as they define their life’s meaning. The individuality
of spirituality is the antithesis of a person’s daily work
and lifestyle. Nursing professionals need to respect the spiritual
elements of each person’s life. In acknowledging and supporting
spirituality, a person’s sense of self is both affirmed and
Hope as an Engaging Process
People have goals in life which at the same time may be quite
simple and complex. A person’s hope for the future involves
goals to be achieved and actions to be explored. Nurses, because
of their knowledge base and their experience, often have clearly
defined health goals and outcomes which may be foreign and
even unacceptable to the individual. While we work with them
to explore and accept our therapeutic goals we must carefully
recognise the goals of the individual. Nursing and its research
need to respect each person’s goals in life and their hopes.
Here I am reminded of the many occasions in
my career when patients have opened my eyes and taught me.
These significant events have guided my practice. The elderly
man living with dementia who was physically withdrawn and
verbally uncommunicative, yet on a special social occasion
singing that beautiful Irish ballad, Danny Boy, word
perfect and full of emotion; the young man’s fears of dying
as he waited for a relatively straightforward investigation
of his cerebral blood flow and who subsequently died before
he regained consciousness; and the elderly woman’s desire
to return to her home and to her only companion, her dog,
before she died from her next heart attack.
These people taught me to listen to every
word expressed and to seek an understanding that people have
much insight when confronted by serious illness and impending
death. It also taught me to recognise what was important to
them and to their life.
Nursing and Spirituality
Interest in the concept of
spirituality has increased markedly over the past decade and
is reflected in both general and health care literature. Nurses,
in their many and varied roles, are in a pivotal position
to provide spiritual caring. An understanding of the spiritual
self will carve a niche in nurses’ abilities to provide truly
Recently at a public forum I was surprised
to hear the question asked: Is it really the nurse’s role
to provide spiritual care? This represents a limited view
of both nursing and spirituality. If spiritual care is not
provided by nurses, both the nurse and the person in need
of such care, are impoverished. Nurses do provide spiritual
care often as a subtext to their caring role. It is now time
to recognise, articulate and claim this important element
of nursing. These concepts can be articulated through our
clinical nursing research.
While spiritual beliefs are generally considered
to be a private concern, the need for spiritual caring is
often foremost for individuals when challenges to health occur.
The meaning of one’s life and purpose, sense of hope, and
belief in oneself and a power beyond self are confronted and
questioned. Nurses have a ‘presence’ in these times of significant
stress and turmoil. They are there to listen, to reflect,
to clarify and importantly, to foster hope.
According to Thomas Moore, in his book, Care
of the Soul, ‘Spirituality is seeded, germinates, sprouts
and blossoms in the mundane. It is found and nurtured in the
smallest of daily activities....the spirituality that feeds
the soul and ultimately heals our psychological wounds may
be found in those sacred objects that dress themselves in
the accoutrements of the ordinary’ (Moore, 1994: 219).
A single event that occurred early in my nursing
career I now recognise as a spiritual one - an awakening which
emerges periodically in my work and which holds great meaning
for me. This spiritual awakening occurred as I was drying
the feet of an elderly man residing in a large aged care facility
in rural Victoria. I was working as an educator of student
nurses. For a brief moment in time I was struck by the translucency
and radiance of the thin, pale, aged skin on this man’s feet.
This caring act represented to me the service role of nursing.
I then understood at a very deep level that I was both immensely
privileged and humbled to possess the skills to perform such
a relatively simple, yet enormously important act of caring.
It was a most valuable of human tasks - being at one with
the needs of this undemanding and vulnerable elderly man.
Much later I was to recognise this was an experience of ‘vernacular
spirituality’, an appreciation of the sacred in the ordinary
(Sexson in Moore, 1994, p. 215) which, according to Moore,
as a spirituality, while being ‘ordinary and close to home,
is especially nourishing to the soul’ (p. 215). At that time
in my career it awakened my identity as a gerontic nurse and
confirmed the meaning and value of nursing in my life.
Spirituality and nursing are historically
and inextricably interwoven. ‘The soul needs spirit, but our
spirituality also needs the soul - deep intelligence, a sensitivity
to the symbolic and metaphoric life, genuine community, and
attachment to the world’ (Moore, 1994, p. 229). Nursing’s
philosophy of caring and its founding beliefs are commensurate
with these concepts. In addition, nursing research can benefit
from recognising this important element in each person’s life.
Spirituality, in its truest sense, is not
contained by any cultural boundaries. Nursing can be considered
a Caring Spirituality to which each of us contribute
through our individual nursing work. Such a contribution will
add new meaning to our nursing care and from which our spiritual
self may grow. The way forward is to acknowledge that each
person has a spiritual self and to recognise the spiritual
expressions of those in need of nursing care. Simple affirmation
of people’s spiritual needs, such as their search for meaning
and the need for love, will enhance spiritual caring in nursing.
People’s hopes are an expression of their spirituality.
Farran, C.J., Wilken, C. and Popovich, J.M.
(1992) Clinical assessment of hope, Issues in Mental Health
Nursing, 13, pp. 129-138.
Gaskin, S. and Forte, L. (1995) The meaning
of hope: implications for nursing practice and research, Journal
of Gerontological Nursing, 21:3, pp. !7-24.
Mayeroff, M. (1971) On Caring, Harper Perennial,
McKinlay, E. Ageing, spirituality and the
nursing role, in Ronaldson, S.M., editor (1997) Spirituality
The Heart of Nursing. Ausmed Publications, Melbourne, p. 101.
Moore, T. (1994) Care of the Soul, Harper
Perennial, New York.
Ronaldson, S.M. (1997) (Editor) Spirituality,
The Heart of Nursing. Ausmed Publications. Melbourne.
Sexson, L, Ordinarily sacred, in Moore, T.
(1994) Care of the Soul. Harper Perennial, New York, p. 215.