This paper raises some issues about understanding religion, religions and spirituality in health care to enable a more critical mutual engagement and dialogue to take place between health care institutions and religious communities and believers. Understanding religions and religious people is a complex, interesting matter. Taking into account the whole reality of religion and spirituality is not just about meeting specific needs, nor of trying to ensure that religious people abandon their distinctive beliefs and insights when they engage with health (...) care institutions and policies. Members of religious groups and communities form an integral part of the structure and fabric of health care delivery, whether as users or in delivery capacities. Religion is both facilitator and resistor, friend and critic, for health care institutions, providers and workers. (shrink)

In recent years, there have been a number of philosophical publications focusing on spirituality. But even in pertinent philosophical texts it is rare to find attempts at shaping a workable definition of spirituality, despite the obvious need for a clear definition for the philosophical debate on spirituality. This paper addresses the major issues in shaping a satisfactory definition of spirituality: an understanding of spirituality as transcendence of critical reasoning, the broadness of the concept, the implications of various scholarly backgrounds and (...) the challenge of avoiding a circular definition. It suggests a rough clustering of common approaches into ontological, ethical, and functional definitions and discusses their weaknesses. It is argued that an inclusive, metaphysically parsimonious, and stipulative definition is the best way to address typical difficulties and avoid weaknesses of common definitions. Finally, it proposes a definition based on meaning, a term that often appears in the discussion of spirituality. It is suggested that understanding meaning in the ordinary sense of the word might be a good starting point to arrive at a satisfactory definition of spirituality. (shrink)

On ancient maps unexplored lands were simply labeled ‘there be dragons’ indicating the fear that attends the unknown. Despite three decades of theoretical and empirical work on spirituality in nursing, evidence still suggests that nurses do not feel competent to engage in spiritual care. In this paper I propose that one of the reasons for this is a theory–theory gap between religion and spirituality. Generalized anxiety about the role of religion in society has led to under‐theorizing in nursing about religious (...) care. As a result, when religion and spirituality overlap at the point of care, nurses are left without the substantive knowledge required for practice. Robust religious theorizing should include thick accounts of lived religion and integrative work that enables nurses to understand commonalities across religions that are relevant to practice. As a starting point to this integrative work, nurses can be introduced to the nature and lexicon of lived religion, religious perspectives on suffering, and religious reasoning that holds meaning and mystery in tension. Such an approach will better prepare them for the realities of practice where the complexities of spirituality and religion come to play. (shrink)

I have been reading Nursing Philosophy since its inception in 2000. Indeed, the journal has played an important role in the development of my thinking—from a doctoral student in philosophy to the pres‐ent day. The invitation to write an article commentary as an editorial board member presented an opportunity to look over previous issues (including well‐worn paper copies from the years before it became a digital‐only publication), a task I have relished over the first months of 2019. Despite my long (...) relationship with the journal, selecting a focus for my commentary was not difficult; two articles on spiritual‐ity in nursing, by John Paley (2008a) and Barb Pesut (2008a), respec‐tively, are touchstones to which I have returned many times in the 11 years since their publication. In this commentary, I present a brief summary of the articles followed by a reflection on their value for nurses and philosophers of nursing. (shrink)

John Paley has rightly observed that, while spirituality is widely discussed in the nursing literature, the discussions are uncritical and unproblematic. In an effort ‘to reconfigure the spirituality‐in‐nursing debate, and to position it where it belongs: in the literature on health psychology and social psychology, and not in a disciplinary cul‐de‐sac labelled “unfathomable mystery” ’, Paley has proposed an alternative, reductionist approach to spirituality. In this paper, I identify two critiques developed by Paley: one political, the other ‘logical’. Paley's political (...) critique claims the concept of ‘spirituality’ has been appropriated by nursing theorists as part of an attempt to accrue professional power and jurisdiction over occupational territory. I suggest that Paley's analysis masks his own exclusivist, secularizing jurisdictional claim made at the expense of spirituality. Paley's so‐called ‘logical’ critique is motivated by an intention to ‘determine what the “spirituality” terrain looks like from the naturalistic point of view’. However, noting a number of inconsistencies, I challenge his ‘logical move’ as a naïve attack on a straw man. In place of Paley's reductionism, I propose my own alternative alternative and argue (after Foucault) that ‘spirituality’ is a discourse, a non‐reductionist attempt, in a post‐religious society, to speak about the human condition open to the unknown. I conclude with a definition and a description of empirically congruent spirituality. (shrink)

Spirituality is a highly contested concept. Within the nursing literature, there are a huge range and diversity of definitions, some of which appear coherent whereas others seem quite disparate and unconnected. This vagueness within the nursing literature has led some to suggest that spirituality is so diverse as to be meaningless. Are the critics correct in asserting that the vagueness that surrounds spirituality invalidates it as a significant aspect of care? We think not. It is in fact the vagueness of (...) the concept that is its strength and value. In this paper, we offer a critique of the general apologetic that surrounds the use of the language of spirituality in nursing. With the critics, we agree that the term ‘spirituality’ is used in endlessly different and loose ways. Similarly, we agree that these varied definitions may not refer to constant essences or objects within people or in the world. However, we fundamentally disagree that this makes spirituality irrelevant or of little practical utility. Quite the opposite; properly understood, the vagueness and lack of clarity around the term spirituality is actually a strength that has powerful political, social, and clinical implications. We develop an understanding of spirituality as a way of naming absences and recognizing gaps in healthcare provision as well as a prophetic challenge to some of the ways in which we practise health care within a secular and sometimes secularizing context such as the National Health Service. (shrink)

Immer mehr Menschen verbringen ihren Lebensabend in Einrichtungen der Altenpflege. Zusätzlich zur Sorge um physische, psychische und soziale Belange gilt es, deren spirituelle Bedürfnisse zu berücksichtigen. Ziel dieser Arbeit war es, die spirituellen Bedürfnisse von alten Menschen in Langzeitpflegeeinrichtungen zu erfassen. Gleichzeitig wurde untersucht, welche spirituellen Bedürfnisse Pflegende bei den ihnen anvertrauten Bewohner/-innen wahrnehmen. Dabei wurden Übereinstimmungen bzw. Unterschiede identifiziert. Daten aus 28 Einzelinterviews mit Bewohnerinnen und Bewohnern und 9 Fokusgruppeninterviews mit Mitarbeitenden wurden mittels Qualitativer Inhaltsanalyse ausgewertet und unter die (...) Kernkategorien „Sinn“, „Verbundenheit“, „Transzendenz“ kategorisiert. Die Kategorien beider Befragtengruppen wurden einem Vergleich unterzogen. Trotz zahlreicher Übereinstimmungen in den Aussagen beider Gruppen bleiben Defizite in der Wahrnehmung von Pflegenden. Aus den Ergebnissen der Arbeit werden Schlussfolgerungen für die Einbeziehung der spirituellen Dimension der alten Menschen in die pflegerische Arbeit im Seniorenheim gezogen und Empfehlungen ausgesprochen. (shrink)

PeterKevern believes that the cognitive science of religion (CSR) provides a justification for the idea of spiritual care in the health services. In this paper, I suggest that he is mistaken on two counts. First,CSRdoes not entail the conclusionsKevern wants to draw. His treatment of it consists largely of nonsequiturs. I show this by presenting an account ofCSR, and then explaining whyKevern's reasons for thinking it rescues ‘spirituality’ discourse do not work. Second, the debate about spirituality‐in‐health is about classification: what (...) shall count as a ‘spiritual need’ and what shall count as ‘spiritual care’. It is about the politics of meaning, an exercise in persuasive definition. The function of ‘spirituality’ talk in health care is to change the denotation of ‘spiritual’, and attach its indelibly religious connotations to as many health‐related concepts and practices as possible.CSR, however plausible it may be as a theory of the origins and pervasiveness of religious belief, is irrelevant to this debate. (shrink)

North American society has undergone a period of sacralization where ideas of spirituality have increasingly been infused into the public domain. This sacralization is particularly evident in the nursing discourse where it is common to find claims about the nature of persons as inherently spiritual, about what a spiritually healthy person looks like and about the environment as spiritually energetic and interconnected. Nursing theoretical thinking has also used claims about the nature of persons, health, and the environment to attempt to (...) establish a unified ontology for the discipline. However, despite this common ground, there has been little discussion about the intersections between nursing philosophic thinking and the spirituality in nursing discourse, or about the challenges of adopting a common view of these claims within a spiritually pluralist society. The purpose of this paper is to discuss the call for ontological unity within nursing philosophic thinking in the context of the sacralization of a diverse society. I will begin with a discussion of secularization and sacralization, illustrating the diversity of beliefs and experiences that characterize the current trend towards sacralization. I will then discuss the challenges of a unified ontological perspective, or closed world view, for this diversity, using examples from both a naturalistic and a unitary perspective. I will conclude by arguing for a unified approach within nursing ethics rather than nursing ontology. (shrink)

Background: Spirituality has always been present in the history of nursing and continues to be a topic of nursing interest. Spirituality has ancient roots. The term ‘spirituality’ is interpreted as spirit and is translated as breath and soul, whereas spirituality (immateriality) is spiritual nature. Historically, the term spirituality is associated with the term religiosity, a definition that persists today, and often the two terms are used interchangeably. In the healthcare context, the construct is still. Objective To clarify the concept of (...) spirituality in nursing. Research design In this article spirituality was explored using Rodgers' evolutionary and inductive method of concept analysis. Participants and research context For this analysis, a sample of 71 articles published in English, from 2008 to 2018 from PubMed/Medline, CINAHL Plus with full text, PsycINFO, SciELO databases were retrieved. It was also accomplished an empirical search of dictionaries and e-books. Ethical considerations This study was conducted according to good scientific practice. Findings It emerged that “spirituality” is a dynamic process and has a range of attributes. The cultural dimensions, the religious and spiritual traditions, the ethnic diversity and the influence of the historical and social contexts represent the societal and historical conditions ingrained in the Western thought that influence the emergence of spirituality as a concept. Antecedents, attributes and onsequences appeared to inform and strengthen one another over time. Spirituality is a significant concept for the discipline of nursing with profound consequences for caring patients and for work organizations. (shrink)

The article offers a critical analysis of the cognitive science of religion (CSR) as applied to new and quasi-religious movements, and uncovers implicit conceptual and theoretical commitments of the approach. A discussion of CSR’s application to new religious movement (NRM) case studies (charismatic leadership, paradise representations, Aḥmadiyya, and the International Society for Krishna Consciousness) identifies concerns about the theorized relationship between CSR and wider socio-cultural factors, and proposals for CSR’s implication in wider processes are discussed. The main discussion analyses three (...) themes in recent work relating CSR to religious and religion-like activities that extend and reframe the model. These include (1) identification of distinctive and accessible cognitive pathways associated with new forms of religious belief and practice (in particular in ‘New Age’ movements), (2) application of CSR to movements and practices outside traditional definitions of religion (near death experiences, conspiracy theories, virtual reality), and (3) engaging CSR in wider cultural processes and negotiations (religion in healthcare settings, and the definition of the study of esoteric religious traditions within academic domains). The conclusion identifies two particular findings: (1) that application of CSR in these areas renders underlying cognitive processes more available to scrutiny and (2) that CSR is employed to identify and enlarge the category of religion. The conclusion suggests that the study of CSR in its application to NRMs and quasi-religion identifies a wide field of common and overlapping themes and interests in which CSR is a more active operand than is commonly assumed. (shrink)

Those matters that are judged to be spiritual are seen as especially valuable and important. For this reason it is claimed that nurses need to be able to offer spiritual care when appropriate and, to aid them in this, nurse theorists have discussed the nature of spirituality. In a recent debate John Paley has argued that nurses should adopt a naturalistic stance which would enable them to employ the insights of modern science. Barbara Pesut has criticized this thesis, especially as (...) it is applied to palliative care. This paper re-examines this debate with particular attention to the meaning of 'spirituality' and the justification for accepting spiritual and religious theories. It is argued that when we take into consideration the great diversity among religious and spiritual ideas, the lack of rational means of deciding between them when they conflict, and the practicalities of nursing, we find that a spiritual viewpoint is less useful than a naturalistic one, when offering palliative care. (shrink)

As a system of knowledge, nursing has utilized a range of subjects and reconstituted them to reflect the thinking and practice of health care. Often drawn to a holistic model, nursing finds it difficult to resist the reductionist tendencies in biological and medical thinking. In this paper I will propose a relational approach to knowledge that is able to address this issue. The paper argues that biology is not characterized by one stable theory but is often a contentious topic and (...) employs philosophically diverse models in its scientific research. Biology need not be seen as a reductionist science, but reductionism is nonetheless an important current within biological thinking. These reductionist currents can undermine nursing knowledge in four main ways. Firstly, that the conclusions drawn from reductionism go far beyond their data based on an approach that prioritizes biological explanations and eliminates others. Secondly, that the methods employed by biologists are sometimes weak, and the limitations are insufficiently acknowledged. Thirdly, that the assumptions that drive the research agenda are problematic, and finally that uncritical application of these ideas can be potentially disastrous for nursing practice. These issues are explored through an examination of the problems reductionism poses for the issue of gender, mental health, and altruism. I then propose an approach based on critical realism that adopts an anti‐reductionist philosophy that utilizes the conceptual tools of emergence and a relational ontology. (shrink)

Background: Despite the growing importance of spiritual care, the delivery of spiritual care is still an area of disagreement among healthcare providers. Objective: To develop a grounded theory about spiritual care delivery based on Iranian nurses’ perceptions and experiences. A grounded theory approach: A qualitative study using the grounded theory approach. Participants and research context: Data were collected through holding 27 interviews with 25 participants (17 staff nurses, 3 physicians, 3 patients, 1 family member, and 1 nurse assistant). The study (...) setting was the Imam Khomeini Hospital Complex. Sampling was started purposively and continued theoretically. Data analysis was performed by the method proposed by Strauss and Corbin. Ethical consideration: The study was approved by the Ethics Committee of Tarbiat Modares University and the agreement of the administrators of the study setting was got before starting the study. Results: The core category of the study was “Trust building” which reflected the nature of spiritual care delivery by nurses. Trust building was the result of eight main categories or strategies including creating a positive mentality at hospital admission, understanding patients in care circumstances, having a caring presence, adhering to care ethics, developing meaningful relationships, promoting positive thinking and energy, establishing effective communication with patients, and attempting to create a safe therapeutic environment. Poor interprofessional coordination negatively affected this process while living toward developing greater cognizance of divinity and adhering to the principles of professional ethics facilitated it. The outcome of the process was to gain a sense of partial psychological security. Conclusion: The “Trust building” theory can be used as a guide for describing and expanding nurses’ roles in spiritual care delivery, developing care documentation systems and clinical guidelines, and planning educational programs for nursing students and staff nurses. (shrink)

This article has its origins in a 2013 proposal by the author that the concept of ‘spiritual care’ in clinical settings might fruitfully be grounded in the findings of the Cognitive Science of Religion (CSR). In a recent paper, John Paley rejects the central arguments and asserts his conviction that a model for ‘spiritual care’ cannot be derived from the insights of evolutionary psychology. In this article, the author employs a modified form of Fichtean dialectic to examine the contrasting positions (...) and, via a process of analysis and synthesis, identify the key areas for further exploration and research. He concludes, first, that CSR in itself does not provide a sufficient theoretical justification for the notion and practice of ‘spiritual care’; secondly, that any attempt to develop a general theory of spiritual care would need to pay closer attention to the role of historically situated religious communities; and finally, that these objections nevertheless do not amount to an argument against the attempt to provide spiritual care as part of person‐centred care. Instead, a revised model is proposed which has the potential to provide testable predictions in this field. (shrink)

This paper analyses the role chaplaincy plays in providing religious and spiritual care in the UK’s National Health Service. The approach considers both the current practice of chaplains and also the wider changes in society around beliefs and public service provision. Amid a small but growing literature about spirituality, health and illness, I shall argue that the role of the chaplain is changing and that such change is creating pressures on the identity and performance of the chaplain as a religiously (...) authorised health worker. I shall question whether either orthodox belief or religious belonging have any significant bearing on the patients’ demand for chaplaincy services. Utilising an example of chaplaincy work I shall argue that patient need constitutes the strongest platform for both practice development and an articulated understanding of what chaplains bring to health care. Drawing on a case study the definition and interpretation of spiritual need will be discussed in relation to chaplaincy practice. In conclusion, I shall set out the case for effective research to establish with greater precision the detail of the chaplain’s practice within a state-funded health system. (shrink)

The tremendous growth in nursing literature about spirituality has garnered proportionately little critique. Part of the reason may be that the broad generalizing claims typical of this literature have not been sufficiently explicated so that their particular implications for a practice discipline could be evaluated. Further, conceptualizations that attempt to encompass all possible views are difficult to challenge outside of a particular location. However, once one assumes a particular location in relation to spirituality, then the question becomes how one resolves (...) the tension between what are essentially theological or philosophical commitments and professional commitments. In this study, we discuss the tension between these perspectives using the idea of a responsible nursing response to spiritual pluralism. We then problematize three claims about spirituality in nursing discourse based upon our location as scholars influenced by Christian theological understandings: (i) the claim that all individuals are spiritual; (ii) the claim that human spirituality can be assessed and evaluated; and (iii) the claim that spirituality is a proper domain of nursing’s concern and intervention. We conclude by suggesting that the widely shared values of social justice, compassion and human dignity may well serve as a grounding for the critique of spiritual discourses in nursing across particularized positions. (shrink)

The work of Jacques Derrida has received relatively little attention within nursing philosophy. Perhaps this is because Derrida is known best for deconstructing philosophy itself, a task he performed by making language unintelligible to make a point. This in itself makes his work daunting for nurses who do applied philosophy. Despite these difficulties, Derrida's focus on holding open a space for ideas, particularly those ideas that are invisible or unpopular, holds potential for enhancing the diversity of ideas within nursing. His (...) work, liberally scattered with religious references, and focused on deconstructing language that served the profits of a few, earned him the characterization of a prophet without religion. This idea was further supported in the way his deconstruction attempted to keep spaces open for the un‐representable and its generativity in opening new possibilities in life. A deconstruction for generative purposes is particularly helpful within palliative care where language quickly takes on dogma in the face of mystery and where new possibilities support life amidst the irrevocable nature of death. In this article, I discuss Derrida's deconstructive approach of differance and then apply that approach to language common in palliative care. (shrink)

Several authors have commented on my reductionist account of spirituality in nursing, describing it variously as naïve, disrespectful, demeaning, paternalistic, arrogant, reifying, indicative of a closed mind, akin to positivism, a procrustean bed, a perpetuation of fraud, a matter of faith, an attempt to secure ideological power, and a perspective that puritanically forbids interesting philosophical topics. In responding to this list of felonies and misdemeanours, I try to justify my excesses by arguing that the critics have not really understood what (...) reductionism involves; that rejecting reductionism is not the same as providing arguments against it; that the ethical dilemmas allegedly associated with reductionist views are endemic to health care; that 'reifying' is what believers in the spiritual realm do; and that the closed minds belong to those who dismiss reductionist science without having studied its achievements. (shrink)