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 of caring.

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 process.

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 respected.

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 holistic care.

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.

REFERENCES

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, New York.

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.