Nursing the spirit: the Framework of Systemic Organization

Self-Management in Older Pakistanis Living With Multimorbidity in East London

In this article, we explore how older British Pakistani people experience multimorbidity (defined as the coexistence of two or more medical conditions) and engage with self-management within the context of their life histories and relationships. We conducted biographical narrative interviews in Urdu and/or English with 15 first-generation Pakistani migrants living with multimorbidity, at their homes in East London. Our analysis showed that the triadic construct of family, faith, and health was central to how participants made sense of their lives, constituting notions of "managing" in the context of multimorbidity. For Pakistani patients, the lived experience of health was inseparable from a situated context of family and faith. Our findings have implications for existing public health strategies of self-management, underpinned by neoliberal discourses that focus on individual responsibility and agency. Health care provision needs to better integrate the importance of relationships between family, faith, and health when developing services for these patients.

Nurses' Use of Spiritual Practices in Caring for Self During the Pandemic

Stressful life events often disrupt individuals' assumptive world, challenging their self-identity and altering their lives. Suffering from stressful life events may have a profound negative impact on a person's life. Nurses felt great demands on their spiritual selves even as they responded to the grave situations and caring demands needed to care for the spirits of their patients during the coronavirus (COVID-19) pandemic. However, with intentionality, suffering and stress can be ameliorated by engaging in spiritual self-care and self-renewing activities. Spirituality is recognized as an essential factor in a person's health and well-being and is integral to the process of growing through life events, such as illness, grief, and bereavement. Nurses may choose to use spiritual practices, either religious or nonreligious, to buffer the effects of stressful life events. The concept of caring for self has long being promoted, by scholars, as an essential need of nurses to care for themselves, not so they can keep on giving to others but because each nurse is worthy of being cared for by self. In the era of the pandemic in which stressful work environment, social distancing, and self-isolation make it difficult to maintain interconnectedness and build relationships, despair can occur. Spiritual practices are examples of the resources that can be used effectively in times of stress to reduce the negativity that life stressors create in individuals.

Cultural Context of Family Religiosity/Spirituality among Korean-American Elderly Families

The purpose of this study is to explore the cultural context of family religiosity/spirituality among Korean-American elderly families, and how this changed after families immigrated to the USA. Fifty one first-generation Korean-Americans participated in one or two hour, in-depth interviews in Korean at a participant's home or church. These included 27 older adults and 24 family members living together or within a radius of one-hour transit time from their elders, residing in the Southeastern United States. A thematic and interpretive method was used to analyze transcribed interviews. Three themes were identified that explained the cultural context of family religiosity/spirituality: (a) traditional family religious rituals, (b) church oriented routines, and (c) family collectivism. The participants did not distinguish 'religiosity' and 'spirituality' during the interviews. The findings suggest that the family religiosity/spirituality of the participants was influenced by the traditional family religious values, which were shaped by Korean culture. The traditional religions of Shamanism, Buddhism, and Confucianism are prevalent in Asian countries. Thus, the findings of this study may help healthcare professionals identify the cultural contexts of spirituality/religiosity of Asian immigrant families in order to provide holistic care.

Interconnections: Spirituality, Spiritual Care, and Patient-Centered Care

The interconnections of spirituality, spiritual care (SC), and patient-centered care (PCC) have implications for advanced practice nurses (APNs) and specialty care nurses (SNs) in their everyday practice. Spirituality has been identified as an inner resource for health, promoting hope, coping, and resilience during illness concerns; encouraging health promotion and maintenance; and improving patient outcomes. SC supports this inner resource and is provided by others. Systems can help facilitate SC by supporting the inter-personal relationships as well as transdisciplinary collaborations of PCC models. SC and PCC occur within inter-personal relationships and specific healthcare environments or systems when implementing them within a spirituality framework. This article provides a brief review on conceptual definitions of spirituality, SC, and PCC models and their relationship to each other within the inter-personal connections. Exploration of implementing such care in practice is presented. Search parameters for this review included manuscripts which provided conceptual as well as quantitative and qualitative research between 1990 and 2018, in English only, with keywords of spirituality, SC, PCC, nurse, nurse practitioner, APNs, and systems. Databases searched included CINHAL, Medline, PubMed, ALTA Religion, Psych-INFO, and Ovid. Articles included in this review were based on research of the above concepts as well as operationalizing the concepts into practice.

Bienestar espiritual en el ámbito hospitalario: aportes para la humanización en salud

El objetivo del presente artículo es determinar el bienestar espiritual (BE) del personal de enfermería y su aporte ético a la humanización en salud. El método seguido corresponde al enfoque cuantitativo, descriptivo, transversal. El muestreo es no probabilístico, constituido por 148 enfermeros de dos instituciones de salud de la ciudad de Bogotá (A y B). Se aplicó instrumento SHALOM-3 para medir el bienestar espiritual (disonancia y armonía) en los dominios personal, trascendental, ambiental y comunal. En cuanto a los resultados, la evaluación del BE mostró un alto porcentaje de armonía en las dos instituciones; sin embargo, se encontraron porcentajes de disonancia en la institución B, en los dominios trascendental (16 % vs 22 %), ambiental (12 % vs 19 %) y personal (11% vs 18%). Se destaca la importancia del Bienestar Espiritual para la humanización de los servicios de salud en el ámbito hospitalario, dado que contribuye a la mejora continua y a la garantía de calidad, preocupaciones relevantes para la bioética en el estudio del clima ético en las instituciones de salud.

Family Spirituality and Family Health Among Korean-American Elderly Couples

Spirituality has been regarded as an individual and private matter; consequently, research on spirituality as a family phenomenon has been largely neglected. In addition, most published research has been focused on Western cultures. The purpose of this study was to explore the experience of family spirituality and how it influences health among Korean-American elderly couples who are the first generation to reside in the Southeastern USA. A thematic and interpretive data analysis method was used. Thirteen elderly couples (N = 26) participated in in-depth individual interviews in Korean with the primary author. Interviews were audio-taped, transcribed, and then translated by two bilingual researchers with a background in Korean and American culture. Three main themes of family spirituality were identified: (1) family togetherness, (2) family interdependence, and (3) family coping. Also, participants reported that family spirituality strengthened family health by fostering family commitment, improving emotional well-being, developing new healthy behaviors, and providing healing experiences. This finding implies that healthcare providers need to assess family spiritual issues of elderly couples to maximize their strengths for coping with health problems. As our society becomes more culturally diverse, healthcare providers should seek to understand family spirituality from different cultural perspectives to develop a more holistic approach to care.

Forgiveness and health in christian women

Researchers in psychology have studied the influence of forgiveness on the both the psychological and physical health of individuals. In addition, parish nursing is also looking at forgiveness as a potential benefit for self-care and health promotion. Forgiveness was measured using Enright's Forgiveness Inventory. Health was measured using Spielberg's State/Trait Anger measure, Beck's II Depression measure, SPF-15 Health Survey. Body Mass Index was also calculated. Mixed Methods was also used to describe the qualitative findings using content analysis on the types of unjust violations Christian women experienced. Women expressed very severe unjust violations involving sexual, physical, emotional, financial and spiritual abuse. Statistical correlations suggested important relationships among forgiveness and overall health measures warranting further investigation. The relationship between Church type and forgiveness raised questions about women's role in the Church as well as, the importance of acknowledging personal feelings, which are excluded in many orthodox denomination's doctrines.

Determining intensive care unit nurses' perceptions and practice levels of spiritual care in Turkey

PURPOSE

The purpose of this study is to determine the validity and reliability of the Turkish version of the Spiritual Care Perceptions and Practices Scale and to evaluate factors that may be effective in providing spiritual care by general intensive care unit (ICU) nurses.

BACKGROUND

Spiritual needs are necessary to offset spiritual deficiencies or support moral strength. During hospitalization, patients with critical conditions and their families tend to become anxious because of fear of the unknown and an uncertain future. Spiritual issues become prominent concerns for these patients and their families.

METHOD

The data of the study were collected from a university hospital, two public hospitals and two private hospitals. A total of 170 nurses were in the ICU of these hospitals, and 123 nurses (79·4%), agreed to participate and, were included in this study. Prior to the study, an information sheet was provided to all nurses to explain the purpose and procedures of the survey. The demographic data form of ICU nurses and the Nurses' Spiritual Care Perceptions and Practices Scale were used for data collection.

RESULTS

A statistically significant difference was found between the marital status of the nurses and the total scale mean score. It was also determined that ICU nurses are in a better position regarding their perception levels of spiritual care compared to their practice levels of spiritual care, and nurses with a higher perception of spiritual care also have higher scores in the practice of spiritual care.

CONCLUSIONS

ICU nurses were found to be inadequate in spiritual care practices. Study findings may be used to improve the support of nurses, to ensure sensitive spiritual care in their daily practices.

RELEVANCE TO CLINICAL PRACTICE

ICU nurses should be aware of the importance of spiritual care and develop tools for assessing the spiritual needs of patients.

The meaning and use of spirituality among African American women living with HIV/AIDS

The purpose of this qualitative study was to explore the meaning and use of spirituality among African American (AA), predominantly Christian women with HIV. A nonrandom sample of 20 AA women from a large infectious disease clinic in Metro-Atlanta participated in the study. The study used focus groups and individual interviews to interview women about their lived spiritual experience. Content analysis and NUDIST software were used to analyze transcripts. The findings revealed the spiritual views and practices of AA women with HIV. The following themes (and subthemes) emerged: Spirituality is a process/journey or connection (connection to God, higher power, or spirit and HIV brought me closer to God), spiritual expression (religion/church attendance, prayer, helping others, having faith), and spiritual benefits (health/healing, spiritual support, inner peace/strength/ability to keep going, and here for a reason or purpose/a second chance). Findings highlight the importance of spirituality in health and well-being among AA women with HIV/AIDS.

Spiritual Well-Being and Health-Related Quality of Life Among African-American Women with HIV/AIDS

Many HIV-positive women regard spirituality as an important part of their lives and spirituality may have positive impact on their health-related quality of life (HRQOL). Particularly among African American women with HIV, spirituality may serve as a cultural and psychological resource. This descriptive, crosssectional study examined associations between spiritual well-being (SWB) and its components, existential well-being (EWB) and religious well-being (RWB), and dimensions of HRQOL among a non-random sample of 118 African American HIV-positive women. A secondary analysis of data from two similar, NIH-funded studies: The Get Busy Living (GBL) Project and the KHARMA Project, was conducted. Baseline data on women from both studies were combined into one database and statistical analyses, including descriptive, correlation and hierarchical regression analyses, were conducted. Existential well-being was significantly positively (β =.74; p=.014) associated with the physical composite of HRQOL and accounted for a significant amount of unique variance (10.0%) beyond that explained by socio-demographic variables, religious well-being (RWB), HIV medication adherence, CD4 cell count and percentage, HIV viral load, and depressive symptoms. EWB was also significantly positively (β =.57; p=.024) associated with the mental health composite of HRQOL. Depressive symptomatology was also significantly inversely (β =.40; p=.004) associated with mental HRQOL. EWB accounted for a significant amount of additional variance (6.3%) beyond that explained by other variables. Spirituality is an important factor in the lives and quality of life of African American women and women living with HIV/AIDS. Further research is needed to examine relationships between spirituality and HRQOL among HIV-positive African American women.

An exploration of the status of spiritual health among nursing students in Taiwan

OBJECTIVE

Few studies have investigated the spiritual health of nursing students. The purpose of this study was to examine spiritual health in a group of senior nursing students in Taiwan, and to explore the factors that influenced the spiritual health of the group.

METHOD

This was a cross-sectional study. A total of 1276 senior nursing students were selected using a probability-proportional-to-size (PPS) procedure, and were asked to complete a self-administrated questionnaire that included a spiritual health scale (SHS) and a demographic profile.

RESULTS

All study participants were female with an average age of 20.1 years, and most reported a religious affiliation and participation in religious activities. Their spiritual health was moderate; and generally the study metric "connection to others" was the highest factor, and the metric "religion attachment" was the lowest. Certain demographic characteristics, including age, education level, aboriginal characteristic, level of religious devotion, and family atmosphere were predictors of spiritual health.

CONCLUSION

Nursing educators should be aware of the impact of spiritual health on nursing students, and should consider developing spiritual and religious education programs to enhance students' spiritual health and to nurture their ability to supply spiritual nursing care for patients.

Spiritual well-being, depressive symptoms, and immune status among women living with HIV/AIDS

Spirituality is a resource some HIV-positive women use to cope with HIV, and it also may have positive impact on physical health. This cross-sectional study examined associations of spiritual well-being, with depressive symptoms, and CD4 cell count and percentages among a non-random sample of 129 predominantly African-American HIV-positive women. Significant inverse associations were observed between depressive symptoms and spiritual well-being (r = -.55, p = .0001), and its components, existential well-being (r = -.62, p = .0001) and religious well-being (r = -.36, p = .0001). Significant positive associations were observed between existential well-being and CD4 cell count (r = .19, p < .05) and also between spiritual well-being (r = .24, p < .05), religious well-being (r = .21, p < .05), and existential well-being (r = .22, p < .05) and CD4 cell percentages. In this sample of HIV-positive women, spiritual well-being, existential well-being, and religious well-being accounted for a significant amount of variance in depressive symptoms and CD4 cell percentages, above and beyond that explained by demographic variables, HIV medication adherence, and HIV viral load (log). Depressive symptoms were not significantly associated with CD4 cell counts or percentages. A significant relationship was observed between spiritual/religious practices (prayer/meditation and reading spiritual/religious material) and depressive symptoms. Further research is needed to examine relationships between spirituality and mental and physical health among HIV-positive women.

The 3 H and BMSEST models for spirituality in multicultural whole-person medicine

PURPOSE

The explosion of evidence in the last decade supporting the role of spirituality in whole-person patient care has prompted proposals for a move to a biopsychosocial-spiritual model for health. Making this paradigm shift in today's multicultural societies poses many challenges, however. This article presents 2 theoretical models that provide common ground for further exploration of the role of spirituality in medicine.

METHODS

The 3 H model (head, heart, hands) and the BMSEST models (body, mind, spirit, environment, social, transcendent) evolved from the author's 12-year experience with curricula development regarding spirituality and medicine, 16-year experience as an attending family physician and educator, lived experience with both Hinduism and Christianity since childhood, and a lifetime study of the world's great spiritual traditions. The models were developed, tested with learners, and refined.

RESULTS

The 3 H model offers a multidimensional definition of spirituality, applicable across cultures and belief systems, that provides opportunities for a common vocabulary for spirituality. Therapeutic options, from general spiritual care (compassion, presence, and the healing relationship), to specialized spiritual care (eg, by clinical chaplains), to spiritual self-care are discussed. The BMSEST model provides a conceptual framework for the role of spirituality in the larger health care context, useful for patient care, education, and research. Interactions among the 6 BMSEST components, with references to ongoing research, are proposed.

CONCLUSIONS

Including spirituality in whole-person care is a way of furthering our understanding of the complexities of human health and well-being. The 3 H and BMSEST models suggest a multidimensional and multidisciplinary approach based on universal concepts and a foundation in both the art and science of medicine.

Maintaining the continuity of care in community children's nursing caseloads in a service for children with life-limiting, life-threatening or chronic health conditions: a qualitative analysis

AIMS AND OBJECTIVES

To explore the factors that influence community children's nurses' (CCNs') perceptions of their workload. To identify ways that CCNs develop and maintain continuity of care and carer.

BACKGROUND

The notion of continuity of care/carer has been central to nursing development for the last 30 years. In the literature, community nursing is used to illustrate the concepts of responsibility relationships and continuity of care/carer. However, an assumption is made that the case allocation method is assumed to be the norm in community nursing. The recent UK literature indicates that the case allocation method is not necessarily working in community nursing. It suggests that there may be continuity of care via teams of community nurses and health care assistants, but not necessarily continuity of carer. This seems to reinforce the notion that ideas about the nature of nursing work, the relationship between nurse and client and the mode of care are constructed, contextual and not self-evident. Little has been written about this regarding CCN work.

DESIGN

Collaborative action research design using qualitative methods.

METHODS

In depth interviews with six CCNs drawn from a NHS funded, PCT hosted CCN service in the West of England; documentary analysis of caseload data; thematic analysis of analytical memos and field-notes.

RESULTS

The analysis of the CCNs' interviews identified the mechanisms and strategies they used for managing their work, meeting clients' needs while ensuring that continuity of care and carer was maintained. From their responses to questions, the responsibility relationship and autonomy characteristics of their role were perceived to be a good thing. However, they acknowledged that working in such a way is stressful and provided examples from their everyday working lives. They emphasised the role of support from colleagues as an important way of maintaining and sustaining the responsibility relationships inherent in their work pattern.

CONCLUSIONS

The findings from this study seem to support the notions prevalent in the literature that ideas about the nature of nursing work, the relationship between nurse and client and the mode of care are socially constructed and automatically given. The group of CCNs in this project actively manage their caseloads to maintain the continuity of care and carer in a particular model of service delivery.

RELEVANCE TO CLINICAL PRACTICE

This project provides some illustrations of the way continuity of care may be achieved at the informational, management and relational levels of practice. The typology of continuity of care allows the discrete areas of CCN work to be highlighted and explored, providing insights on an area of practice that is under-reported. The study provides a basis for future research to examine the different configurations of CCN services for the same client group or services for different clients, e.g. diabetes care, so that service providers may configure provision to meet children's and their family's needs.

Patients' conceptions of how the spiritual dimension is addressed in mental health care: a qualitative study

AIM

This paper reports a study to describe patients' conceptions of how the spiritual dimension is addressed in mental health care.

BACKGROUND

Spirituality is a broad concept, and is highly subjective, multidimensional and difficult to define. Spirituality and religiousness are two separate concepts but have several common features. In mental health care, it is essential that nursing care be built on a holistic view, and the spiritual dimension has an important function in nursing care. The notion of spirituality is full of nuances, and in a multi-cultural society patients express their spirituality in different ways.

METHOD

Data were collected by interviewing 12 strategically selected patients in mental health care and analysed according to a qualitative method inspired by the phenomenographic approach. The data were collected in 2003 in Sweden.

FINDINGS

Three descriptive categories emerged: patients wish to have their spiritual needs addressed; patients must see to it that their spiritual needs are addressed; patients lack confidence in nurses with regard to discussing spirituality. The findings show that patients actively sought the assistance of nurses to meet their spiritual needs. They turned their thoughts inwards and found community with other patients, while nurses often avoided addressing the spiritual dimension.

CONCLUSION

Nurses should work actively to seek new knowledge about how they can address patients' spiritual needs. It is also important that there be scope for discussing and reflecting on spiritual questions at the workplace. Additional research is needed to explore how knowledge about spirituality should be implemented in mental health care and nursing education.

From spirituality to coping strategy: making sense of chronic illness

This article explores how individuals might make sense of chronic illness. The spiritual aspect of self is described both as being central to finding meaning in suffering with a chronic illness and also the source of hope in meeting the challenges faced. Culture as the template for interpreting the significance of chronic ill health at a personal, familial and societal level is also considered. A conceptual model for understanding life transitions is modified to incorporate the spiritual and cultural perspectives of making sense of chronic illness in relation to coping skills. In understanding how patients make sense of their circumstances nurses are more likely to be able to offer appropriate support to effect coping.

Spirituality, mental health, physical health, and health-related quality of life among women with HIV/AIDS: integrating spirituality into mental health care

HIV-positive women have used spirituality as a resource to enhance their psychological well-being and health-related quality of life (HRQOL). The purpose of this article is to review the literature about depression among HIV-positive women and to describe the positive associations reported among spirituality, mental health, and HRQOL. This article also advocates the development and use of interventions integrated with spirituality. The incorporation of spirituality into traditional mental health practices can optimize healthcare for HIV-positive women who are diagnosed with depression. A case example is presented and spiritual implications are discussed.

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.

How the spiritual dimension is addressed in psychiatric patient-nurse relationships

AIM

This paper reports a study describing nurses' conceptions of how the spiritual dimension is addressed in psychiatric patient-nurse relationships.

BACKGROUND

In psychiatric care, it is essential that patient-nurse relationships be built on a holistic view. In this context, nursing research shows that there is a lack of integration of the spiritual dimension.

METHOD

Twelve strategically selected psychiatric nurses were interviewed and analysed using a phenomenographic approach. The data were collected in 2003.

FINDINGS

The main findings were three descriptive categories: being a good carer, recognizing the spiritual dimension, and regarding the spiritual dimension as difficult to capture in patient-nurse relationships. The first descriptive category shows that nurses deal with spirituality by behaving as good carers. Those included in the second descriptive category reveal nurses who are aware of patients' spiritual needs and who deal with these needs in different ways. The third descriptive category consists of conceptions revealing lack of knowledge of patients' spiritual needs, both in abstract and real terms.

CONCLUSIONS

Further research is needed to explore how patients describe their own spiritual needs, and how nursing staff can learn to be aware of and understand their own spirituality, thus enabling them to detect, discuss, clarify and deal with the concept of spirituality in patient-nurse relationships.

Spiritual issues in surgical palliative care

The key points of this article are: Spirituality gives meaning and purpose to life. Spiritual issues that may lie dormant for many years often surface at the end of life. Not all people are religious, but all are spiritual. Suffering affects the whole person and often is connected to the meaning that a patient associates with a symptom or symptoms. Spiritual history validates the importance of a patient's spirituality and gives permission to the patient for future discussion/questions. Spiritual care is the job of all members of the interdisciplinary team(including surgeons), not just chaplains. It is critical to be open to spiritual discussions/issues as they arise while seeking the assistance of professional pastoral care staff where appropriate. Redefining hope: hospice can help the dying patient to redefine hope in terms of realistic goals-from a hope for cure to a hope for good symptom relief. Reconciliation is the work of the dying. Empathy is the opportunity for those who care for the dying.

Providing spiritual care in end-stage cardiac failure

Spiritual care is an integral component of palliative care, whatever a patient's diagnosis. This article looks at spiritual care from the perspective of providing care for patients living with end-stage heart failure. Such patients face many debilitating symptoms and much uncertainty. The issues of how spiritual needs should be addressed, what spiritual care entails, and the most appropriate person to provide spiritual care are examined.

A kaleidoscope of understandings: spiritual nursing in a multi-faith society

BACKGROUND

Spirituality is an increasingly discussed topic in nursing. In some parts of the UK there is a policy requirement to establish policies of spiritual health care which are appropriate to a multi-cultural society. In the nursing literature, spirituality is discussed from religious and secular perspectives which seem impossible to reconcile into a coherent philosophy.

AIMS

To discuss the relationship of spirituality to nursing and to suggest how we can think about spirituality as nurses working in a society of many faiths and cultures.

DISCUSSION

Spirituality can be thought of in relation to individual patients and nurses. It also has significance for the profession of nursing and for health care as a whole. The difficulty of defining spirituality is discussed, and it is suggested that a definition of 'spiritual nursing' may be more achievable. Different concepts of spirituality are compared, including religious and secular spirituality. The relationship between religion and spirituality is seen as potentially problematic, with some religions denying the existence of secular spirituality. Secular spirituality and New Age movements are non-religious but spiritually influential phenomena. The problem for nursing is how to reconcile the immense variety of approaches to spirituality.

CONCLUSIONS

The concept of spirituality as a meta-narrative is considered, and a postmodern appreciation of pluralism is employed as a way of embracing different spiritual realities. Spiritual nursing can be an opportunity for nurses to enlarge their understanding of the human condition rather than a narrowly defined concept to be applied within a model of practice.

Perceptions of nurses with regard to doctor-patient communication

The objective of this study was to evaluate nurses' perceptions of communication between doctors and patients with cancer, AIDS and rheumatoid arthritis. A cross-sectional study was conducted with 741 nurses in 12 hospitals. Nurses received a self-questionnaire that included questions on personal value and attitudes. The answers were used in constructing affective variables (religious beliefs, attitude towards death, paternalism). The prevalence of explicit communication in 'nurse perception of doctor-patient communication' in the case of cancer was 4.5%, with AIDS 30%, and with rheumatoid arthritis 41.8%. When the value of communication was evaluated, it became evident that the likelihood of a nurse perceiving explicit communication in reference to a diagnosis of cancer was 6.5 time greater when communication was considered to be of greater value (CI 95% 2.6-6.6). For nurses who accept the possibility of death, the likelihood of perceiving explicit communication in the case of AIDs was 7.4 times greater than for nurses who deny this possibility (CI 95% 3.7-14.7), and when nurses displayed a deeply religious attitude, the likelihood of perceiving explicit communication was 80% greater than for nurses without this attitude (CI 95% 1.1-2.9). Nurses participate actively in the process of attending to patients with cancer and other disabling illnesses. Thus, there is a need for health professionals who provide compassionate attention, which will improve the various interrelationships between nurses and patients.