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Understanding Religion and Spirituality in Nursing and Care

Many people are tempted to think that religion and spirituality are the same. These two concepts may exist together, as many religious people have a spiritual component, but not every person is religious. Expressing spirituality through religious practices, compassion, through service to others, or passing on wisdom to the next generations, often brings deep personal satisfactions. Religion is defined to be the practical expression of spirituality, including specific believes and practices. Spirituality is defined as a system of believes, encompassing love, compassion and respect for life. Spirituality provides understanding of us, others and the universe. It represents feelings that people experience and requires abstract thinking and will.

From my perspective, religion can not exist without spirituality. As a religious person, I believe that spirituality represents for me an essential element that strengthens my belief in God. According to my experiences, spirituality is associated to happiness, health and morale. At the same time, I think that being spiritual, means that is not necessary to have religious believes.

For a better understanding of the differences between religion and spirituality, Koening, George and Titus (2004), gave a definition for religion as an organized system of beliefs, practices and symbols, designed to facilitate closeness to higher power, or God, and includes the understanding of one's relationship with him, and responsibility to others. Religion establishes rules or customs such as attending church or synagogue, and participating in prayers or bible study groups. There are non-organizational religious activities that consist of more private and personal behaviors, such as individual meditation, reading the bible, listening to religious radio programs, or watching religious television programs. Sometimes religion is the primary motivating factor in people's lives that drives behaviors, and influences decision making. That is why religious people may cope better with changes in physical health, and recover a lot quicker. Religion offers a way to express spirituality with social support, security, and a sense of belonging through religious affiliations, being significant in coping with age related, physical and emotional changes. Spiritual realities become most important, as the individual plans for his/ her future beyond death. Religious traditions appear to comfort ethnic groups, as they are looking for solutions for their unique problems. On the other hand, according to the same article mentioned above, spirituality is the quest for understanding the meaning and purpose of life, which can or cannot lead to the development of rituals and shared religious community. Many people may not be affiliated wit a religious tradition, but are still involved in a spiritual quest, seeking meanings in something outside their own personal egos. Spirituality is very subjective and means different things to different people. Their own beliefs define what the meaning of spirituality is. According to Tuck (2004), spirituality represents "the integrative force for experience of the whole and critical factor in the healing process. There is empirical evidence that spirituality has positive effects on physical, psychological and spiritual well-being and quality of life"

I strongly believe in spirituality, and I consider it as a search for meaning in life. Being a religious person, I believe in God and God's works. My life is guided by beliefs and practices related to an organized religion. For me spirituality means the purpose of life, peace, emotional balance, and love for the people surrounding me. I like to promote positive attitude around me, to eliminate stress factors, to create harmony, focusing on helping people to achieve a state of comfort and well-being. I also focus on creating safe, healthy and warm environment for people that I am in contact with. I try to integrate all my beliefs into my professional life, by inspiring confidence, compassion and professionalism while caring for my patients. In my professional practice, I am concerned for the welfare of patients, other nurses, and other healthcare providers. I demonstrate understanding of cultures, perspectives and beliefs of others, being a good advocate for my patients. I am respecting the patients, and their rights to make decisions about their healthcare, by planning the nursing care in partnership with my patients, and providing information so that patients can make informed choices. I am designing the care provided by me with sensitivity to the individual patient needs. In my opinion, nursing care should cover all aspects of a person: the physical aspect, as well as the emotional aspect, such as mind and spirit that define us as human beings. I strongly believe that there is a tight correlation between body, soul and illness. Effects of illness over our physical body can influence our emotional, mental and spiritual state. I consider that the nurses' role is to feel and capture the imbalance occurred, and to eliminate the barriers in the patient's healing process. Spiritual care should be a delicate and positive approach, based on trust and good relationship between the patient and nurse in order to provide the best care, to support the patient's hope for a better life. Hope is very important for the patients. It is evident in all specialties of nursing. As a short example I would like to present the case of a twenty-five year old lady, who was admitted to our epilepsy monitoring unit (EMU) for intractable seizures. She had a two years old baby at home, her only child and the light of her life. Her seizures started right after delivering her baby boy. She decided to have a whole work-up done, regarding a possible brain surgery that could offer her a seizure free life, so she could fully enjoy her little baby, and have her life back again. She went through the whole process of subdural grid placement (requiring an initial brain surgery), with the purpose of tracking the seizure focuses, in order to be evaluated. After a whole week of hard work, her evaluation regarding the treatment plan was presented to her by the physicians. According to the findings, she did not qualify to be a good candidate for lobotomy that would stop her seizures. When I went into her room to assess her, I found her quiet, depressed and crying. I postponed my assessment for the moment, asking her if I could offer her any help. Then she started confessing about her broken hope after the evaluation results were reveled. She stated that she feels helpless and hopeless. I gave her time to express her thoughts and feelings, listening patiently, and holding her hands. When she finished, I asked her if she knows what other options she would have for seizure control. Her face suddenly enlightened when heard that there would be other treatment alternatives. I provided her with verbal information and pamphlets about a device called neuro-pacer, which was at the moment in the study phase, but due to her young age, healthy background and type of seizures she was having, she could have been a perfect candidate for it. She stopped crying after this, her attitude had changed, showing sudden interest in finding out more information about the neuro-pacer. This example represents just one of the ways I am providing spiritual care to my patients, giving me the satisfaction of being a nurse.

From the prospective of other religions than Judeo-Christian, the way of understanding spirituality can be very different, due to each person's religious affiliation. The spiritual concept is well known, and developed from Judeo-Christian prospective, and common elements have been identified. Caring for patients with different religions than Christian can be complex and difficult, especially when there is lack of knowledge about their specific beliefs and expectations. When this would be the case, through effective communication nurses can expand self awareness and discover patients' needs. Beside communication with the patient, I try to explore the concept and provide a better picture of my patient's spirituality, using internet, or other resources, such as coworkers or clinical instructors, in order to establish the patient's spiritual plan of care. If the nurses demonstrate knowledge, interest and respect towards their patients' culture, they will gain their patient's confidence. More than this, addressing the patients' spiritual needs contributes to a better outcome of the patient care, and even "several studies have shown that addressing the spiritual needs of the patient may enhance recovery from illness." (Luk, Kwong, Wong and Tsang, 2007)

The role of spirituality in providing holistic care in nursing practice represents a common subject that captured the researchers' interests. In accordance with Sipes (2008), the holistic care in nursing is known as comprehensive care, and considers the patient in its complexity. Holistic care addresses the physical, emotional, social, economical and spiritual needs of a person. Sipes (2008) states that as nurses, we must encourage patients to life as meaningful as possible, to encourage patients who are ill or debilitated, in order to get well and continue life. To do this, we must focus on our patient as a whole system. Spirituality is a key element in providing holistic care that helps to achieve a balance between one's mind and body. The major goal in patient care is obtaining and keeping the balance between mind, body and environment, as this balance is essential for maintaining life:

Neuman describes adjustment as the process by which the organism satisfied its needs.

Many needs exist and each may disrupt client balance or stability; therefore, the

adjustment process is dynamic and continuous. All life is characterized by this ongoing

balance and imbalance within the organism. (Tomey & Alligood, 2006, p.319)

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