Exploring Spirituality through Research: an Important but Challenging Task

The Impact of the Hospice Environment on Patient Spiritual Expression

PURPOSE/OBJECTIVES

To understand how hospital inpatients express their spirituality and to investigate the impact of hospice environment on this expression.

RESEARCH APPROACH

Qualitative.

SETTING

Two metropolitan hospice centers in southern Australia.

PARTICIPANTS

12 inpatients (7 males, 5 females) who were residents for at least four days.

METHODOLOGIC APPROACH

Influenced by Heidegger's Phenomenological Hermeneutics, semistructured interviews were conducted. Interview transcripts and field notes were analyzed to reduce data into codes and themes. Data were coded by extracting verbatim phrases used to describe spiritual expression and the impact of hospice environment on it.

MAIN RESEARCH VARIABLES

The nature of spiritual expression and the impact of the hospice environment on the spiritual expression of hospice inpatients.

FINDINGS

Participants were comfortable discussing their spiritual expression within the context of four main themes: Relationships, That Which Uplifts, Spiritual Practice, and Having Hope. Finding meaning was a common link among these themes. The impact of the hospice environment was variable. Most believed that it facilitated their spiritual expression to some degree.

CONCLUSIONS

Spiritual expression is important but is facilitated by individualized spiritual care. Nurses play an important role in the provision of spiritual care within a hospice setting.

INTERPRETATION

Nurses are significant in assisting in patients' spiritual expression. Nurses' needs for training in listening skills, confidence in discussing spiritual issues, and time to provide individualized spiritual care should be assessed to ensure optimal patient expression.

Religion and spirituality: a discussion paper about negativity, reductionism and differentiation in nursing texts

BACKGROUND

The last 30 years have seen a proliferation of literature about spirituality in the nursing press. A dominant theme has been the need to differentiate spirituality from religion and this has provoked a number of authors to attempt to define and describe religion. As nursing advocates respect for the person's religious beliefs the way in which it is portrayed is very relevant.

AIMS

This work explores how religion is defined and discussed in the nursing literature about spirituality to consider whether the way religion is portrayed could be said to demonstrate 'respect' for religious beliefs.

METHODS

Texts about religion were examined in relation to theories of religion from anthropology, sociology and religious studies. These disciplines have produced substantive or irreducible accounts in contrast to functional and reductive theories about religion.

RESULTS

The result of this analysis is that there appears to be a tendency to talk about religion without using sources which itself suggests a lack of respect as well as an inclination to view it only in reductive and functional terms. This is proved by the similarity of ideas in the nursing literature to the functionalist and reductionist theories of Frazer, Tylor, Marx, Durkheim and Freud. This approach is criticised with reference to the work of Otto, Bellah, Berger and Pals who suggest that religion should be seen as irreducibly to do with the sacred. It is proposed that this is a more appropriate outlook to take for an occupation which professes to respect the religious beliefs of all individuals. However, viewing religion in this more meaningful way, acknowledging their spirituality has implications for attempts to differentiate religion and spirituality.

CONCLUSION

Reductive accounts of religion imply, probably inadvertently but nevertheless negative, attitudes towards religious belief. A more serious and deeper exploration of the meaning of religion from the standpoint of irreducibility might be more respectful and tolerant of religious belief. This is particularly salient in a society where religious practice is increasing both in the indigenous population and as a result of immigration.

Positive outcomes for survivors of haematological malignancies from a spiritual perspective

The findings indicate that there are many potentially positive outcomes, couched in terms of a spiritual journey, to be gained from the experience of serious illness for survivors who are well supported and obtain successful results from treatment. The work is from a qualitative programme exploring the notion of spirituality. The data are from the thematic analysis of verbatim transcriptions of audio-taped, in-depth, open-ended interviews with 12 survivors of haematological malignancies. The results indicate increased confidence and assertiveness, less dependence on the approval of others, greater ability to assert personal needs, increased awareness of body needs, being less judgmental and more compassionate. The positive outcomes also included the gift of extra life, the desire to live life to the fullest, a stronger sense of family togetherness, an awareness of reliable friends and family members, increased respect from others, changes in work values and an overall improvement in quality of life.

Developing a language for nonreligious spirituality in relation to serious illness through research: preliminary findings

The preliminary findings presented in this article are part of a research program that is concerned with exploring the notion of spirituality for those dealing with serious illness. The aim of the program is not only to deepen our understanding of how individuals construct their spirituality in the face of life-threatening illness, but also to respond to such insights by beginning to develop a language reflective of the commonalities of experience. The development of such a language involves a three-phase process including the thematic development of qualitative data, comparative analysis of findings from disparate sample groups, and expert reflection of conceptual notions within the context of the richness of traditional philosophical/theological literature. This discussion focuses on the preliminary process of qualitative data development based on in-depth interviews with survivors of a hematological malignancy. The findings indicate that, for those who have a nonreligious framework, there is no shared language readily available to communicate their insights and experience with serious illness. However, the qualitative analysis also indicates that such survivors share a number of identifiable conceptual notions. These notions are articulated as a preliminary step in language development.

Reflections on serious illness as spiritual journey by survivors of haematological malignancies

Although still in its infancy, research on spirituality is attracting increasing attention in health care. There are ongoing calls within the literature for research directed specifically toward clarifying what people mean by the word 'spiritual' and how they express this dimension in their lives. The findings presented in this article respond to that call by presenting findings from a recent qualitative study on meaning-making in relation to serious illness conducted with survivors of haematological malignancies. The findings indicate that the language of a secular spiritual journey, rather than a conventional religious or theological conceptual framework, was used for meaning-making by the survivors interviewed. Such results affirm the recent definitional move away from conflating religion with spirituality, while pointing to the richness, complexity, and contradiction that individuals bring to their meaning-making. The findings provide important insights on the interpretation of spirituality for a group of individuals surviving the confrontation with death caused by a life-threatening illness.

Exploring the spiritual needs of people dying of lung cancer or heart failure: a prospective qualitative interview study of patients and their carers

BACKGROUND

We set out to explore whether patients with life-threatening illnesses and their informal carers consider they experience significant spiritual needs, in the context of their overall needs, how spiritual concerns might vary by illness group and over the course of the illness, and how patients and their carers think they might be supported in addressing spiritual issues.

METHODS

Three-monthly qualitative interviews for up to one year with 20 patients with inoperable lung cancer and 20 patients with end-stage heart failure and their informal carers.

RESULTS

We conducted 149 in-depth interviews. Spiritual concerns were important for many patients in both groups, both early and later in the illness progression. Whether or not patients and carers held religious beliefs, they expressed needs for love, meaning, purpose and sometimes transcendence. The different experiences of lung cancer and heart failure raised contrasting patterns of spiritual issues and needs. Carers voiced their own spiritual needs. Patients and carers were generally reluctant to raise spiritual issues, but many, in the context of a developing relationship with the researcher, were able to talk about such needs.

CONCLUSIONS

Spiritual issues were significant for many patients in their last year of life and their carers. Many health professionals lack the necessary time and skills to uncover and address such issues. Creating the opportunity for patients and carers to discuss spiritual issues, if they wish, requires highly developed communication skills and adequate time.

Religiosity and the challenge of terminal illness

One of the assumptions that underpins the literature on spirituality is the belief that facing a terminal illness is a life crisis that intensifies the search for meaning, leaving individuals predisposed to embrace religion. To date, however, there is scant empirical research on the topic. This article seeks to make a contribution to this topic by reporting findings from a qualitative study that address the question of whether individuals embrace religious beliefs when faced with the challenge of a serious illness. The data were gathered from open-ended interviews with 14 hospice patients, audiotaped, transcribed verbatim, and thematically analyzed. The findings indicate the majority did not seek religious comfort or conversion as a response to the challenge of terminal illness, even when this was seen as desirable. Although participants were not actively inspired to be religious as a result of their illness, they did hold a number of spiritual perspectives that were actively at play.

Caring for the spirit: lessons from working with the dying

Spiritual care is integral to palliative care, and palliative care experience in offering spiritual care can be a resource for the emerging healthcare interest in spirituality. Spirituality is best understood in terms of the web of relationships that gives coherence to our lives, uniquely identifying each person. In palliative care, responsibility for spiritual care is shared by the whole team, with leadership given by specialist practitioners such as pastoral care workers. The palliative care approach to spiritual care may, however, be transferred to other contexts and to individual practice. Spiritual care encourages and supports people in a quest for meaning and personal autonomy. It is offered, not imposed.

Spiritual pain: a comparison of findings from survivors and hospice patients

The article presents comparative research findings on the notion of "spiritual pain." The findings from interviews with hospice patients affirm the previously published, preliminary conceptualization of spiritual pain from interviews with survivors. However, while the survivor findings highlight the potential for spiritual pain associated with life after high-tech curative treatment, the hospice patient data emphasize the protectiveness of the hospice experience for deflecting the possibility of spiritual pain. It is anticipated the discussion of comparative findings will affirm the importance of researching this "ignored dimension" and, in so doing, will enrich our understanding of the spiritual dimension of healthcare. The work is part of a program presently developing a language of spirituality through research.

Who are our clients? A profile of a community-based Buddhist hospice

One of the ongoing challenges for those involved in the hospice movement is to find ways of effectively extending the provision of hospice services to all in need. Pragmatic, empirical research that provides information on the present and potential hospice population is essential to foster the development of services if this challenge is to be met. This discussion presents a descriptive profile of the clients of a community-based Buddhist hospice in Brisbane, Australia, known as the Karuna Hospice Service (KHS). This descriptive profile makes a contribution to the important task of establishing where we currently are, in the hope that this will begin to delineate where fresh energy needs to be directed in the future.

Spirituality and palliative care: a model of needs

This paper provides a theoretical model of spiritual needs in palliative care based on a review of the palliative care literature. Three sources of transcendence, the building blocks of spiritual meaning, are identified: the situational, the moral and biographical, and the religious. After areas of transcendence are described and explained, implications for future theory, research and practice are identified.