Matteo Ricci (1552-1616), an Italian Jesuit, entered China in 1583 to spread Catholicism in the largely Confucian country. In order to make a persuasive argument for the educated Chinese to abandon their traditional faith for the new one he was carrying, Ricci realized that he would have to prove the general superiority of Western culture. He did so by teaching young Confucian scholars tricks to increase their memory skills–an important advantage in a nation with countless laws and rituals that had to be learned by heart. Ricci attracted numerous students with this method; more important, Ricci came to have a sympathetic understanding for China that he communicated to Rome, and thence to the European nations at large. Spence’s portrait of Ricci is a gem of historical writing. –Gregory MacNamee
Journal of Clinical Nursing, Vol. 13, No. 1. (January 2004), pp. 11-16.
bash a. (2004) Journal of Clinical Nursing13, 11–16 Spirituality: the emperor’s new clothes? Background. This paper explores the concept of ‘spiritualityÂ’ with reference to the PatientsÂ’ Charter that stipulates that a person’s religious, spiritual and cultural needs should be respected at all times. Aims and objectives. The aim is to offer a critical analysis of what the word ‘spiritualityÂ’ may mean when used in the PatientsÂ’ Charter and to explore the implications of this for clinical practice. Design. A critical discussion based on a literature review, examining in particular methodological presuppositions. Methods. The meaning of ‘spiritualityÂ’ in the Judaeo–Christian biblical traditions is explored. Some of the heuristic assumptions in contemporary research on ‘spiritualityÂ’ are examined. Philosophical (i.e. non-scientific) and scientific questions to do with ‘spiritualityÂ’ are disentangled. Results and conclusions. The paper concludes that: (i) ‘SpiritualityÂ’ is an elastic term not capable of universal definition as each person’s spirituality is an individual matter for them and (ii) tools that are being developed for identifying a person’s spirituality run the risk of making wrong presuppositions about what comprises spirituality. Relevance to clinical practice. It is unlikely that tools can be developed that are widely applicable for identifying and assessing spirituality.
Journal of Advanced Nursing, Vol. 48, No. 1. (October 2004), pp. 6-16.
narayanasamy a., clissett p., parumal l., thompson d., annasamy s. & edge r. (2004) Journal of Advanced Nursing48(1), 6–16 Responses to the spiritual needs of older people Background. The literature suggests that the notion of holistic health has gained popularity in the nursing of older persons. Holistic care, based on the premises that there is a balance between body, mind and spirit, is important for well-being, that each of these is interconnected, and that each affects the others. Human spirit is considered to be the essence of being and is what motivates and guides us to live a meaningful existence. However, there is little evidence in the nursing literature about how nurses caring for older people respond to their spiritual needs. Aim. The aim of this paper is to report a critical incident study to: (1) explore nurses’ perceptions of their role in addressing the spiritual needs of older people; (2) describe what constitutes spiritual care of old people in the light of the findings. Methods. Descriptions of critical incidents were obtained from a convenience sample of 52 nurses working in the East Midlands Region of the United Kingdom (UK) and subjected to content analysis and construction of a data classification system. Findings. Respondents were prompted to identify patients’ spiritual needs by factors such as religious beliefs and practice (prayer); absolution; seeking connectedness, comfort and reassurance, healing or searching for meaning and purpose. The interventions initiated to meet patients’ spiritual needs included respect for privacy; helping patients to connect; helping patients to complete unfinished business; listening to patients’ concerns; comforting and reassuring; using personal religious beliefs to assist patients and observation of religious beliefs and practices. Conclusion. The findings provide empirical evidence of some practices related to spiritual care of older people. Further empirical research is needed to guide practice and education with regard to conceptual clarity and the delivery of spiritual care of older people.
BACKGROUND: The large body of empirical research suggesting that patients’ spiritual and existential experiences influence the disease process has raised the need for health care professionals to understand the complexity of patients’ spiritual pain and distress. OBJECTIVE: The current study explores the multidimensional nature of spiritual pain, in patients with end-stage cancer, in relation to physical pain, symptom severity, and emotional distress. DESIGN/MEASUREMENTS: The study combines a quantitative evaluation of participants’ intensity of spiritual pain, physical pain, depression, and intensity of illness, with a qualitative focus on the nature of patients’ spiritual pain and the kinds of interventions patients believed would ameliorate their spiritual pain. SETTING/SUBJECTS: Fifty-seven patients with advanced stage cancer in a palliative care hospital were interviewed by chaplains. RESULTS: Overall, 96% of the patients reported experiencing spiritual pain, but they expressed it in different ways: (1) as an intrapsychic conflict, (2) as interpersonal loss or conflict, or (3) in relation to the divine. Intensity of spiritual pain was correlated with depression (r = 0.43, p < 0.001), but not physical pain or severity of illness. The intensity of spiritual pain did not vary by age, gender, disease course or religious affiliation. CONCLUSIONS: Given both the universality of spiritual pain and the multifaceted nature of pain, we propose that when patients report the experience of pain, more consideration be given to the complexity of the phenomena and that spiritual pain be considered a contributing factor. The authors maintain that spiritual pain left unaddressed both impedes recovery and contributes to the overall suffering of the patient.
Am J Hosp Palliat Care, Vol. 23, No. 1. (b 2006), pp. 25-33.
The purpose of this study was to explore the spiritual concerns of seriously ill patients and the spiritual-care practices of primary care physicians (PCPs). Questionnaires were administered to outpatients (n=65, 90 percent response rate) with end-stage illness and to PCPs (n=67, 87 percent response rate) in a diverse general medicine practice. Most patients (62 percent) and PCPs (68 percent) considered it important that physicians attend to patients ’spiritual concerns. However, few patients reported receiving such care, and most (62 percent) did not think it was the PCP’s job to talk about spiritual concerns. Although both seriously ill outpatients and PCPs assert the importance of spiritual concerns, PCPs often do not provide spiritual care. Appropriate provision of spiritual care within a diverse population of seriously ill outpatients is complex, necessitating appropriate and attentive screening.
Spirituality is essential to healthcare. It is that part of human beings that seeks meaning and purpose in life. Spirituality in the clinical setting can be manifested as spiritual distress or as resources of strength. Patients’ spiritual beliefs can impact diagnosis and treatment. Spiritual care involves an intrinsic aspect of care, which underlies compassionate and altruistic caregiving and is an important element of professionalism amongst the various healthcare professionals. It also involves an extrinsic element, which includes spiritual history, assessment of spiritual issues, as well as resources of strength and incorporation of patients’ spiritual beliefs and practices into the treatment or care plan. Spiritual care is interdisciplinary care-each member of the interdisciplinary team has responsibilities to provide spiritual care. The chaplain is the trained spiritual care expert on the team. Optimally, all healthcare professionals, including the chaplain, on the team interact with each other to develop and implement the spiritual care plan for the patient in a fully collaborative model.
Research related to spirituality and health has developed from relative obscurity to a thriving field of study over the last 20 years both within palliative care and within health care in general. This paper provides a descriptive review of the literature related to spirituality and health, with a special focus on spirituality within palliative and end-of-life care. CINAHL and MEDLINE were searched under the keywords “spirituality” and “palliative.” The review revealed five overarching themes in the general spirituality and health literature: (1) conceptual difficulties related to the term spirituality and proposed solutions; (2) the relationship between spirituality and religion; (3) the effects of spirituality on health; (4) the subjects enrolled in spirituality-related research; and (5) the provision of spiritual care. While the spirituality literature within palliative care shared these overarching characteristics of the broader spirituality and health literature, six specific thematic areas transpired: (1) general discussions of spirituality in palliative care; (2) the spiritual needs of palliative care patients; (3) the nature of hope in palliative care; (4) tools and therapies related to spirituality; (5) effects of religion in palliative care; and (6) spirituality and palliative care professionals. The literature as it relates to these themes is summarized in this review. Spirituality is emerging largely as a concept void of religion, an instrument to be utilized in improving or maintaining health and quality of life, and focussed predominantly on the “self” largely in the form of the patient. While representing an important beginning, the authors suggest that a more integral approach needs to be developed that elicits the experiential nature of spirituality that is shared by patients, family members, and health care professionals alike.
Palliat Med, Vol. 18, No. 7. (October 2004), pp. 646-651.
The delivery of spiritual and religious care has received a high profile in national reports, guidelines and standards since the start of the millennium, yet there is, to date, no recognized definition of spirituality or spiritual care nor a validated assessment tool. This article suggests an alternative to the search for a definition and assessment tool, and seeks to set spiritual care in a practical context by offering a model for spiritual assessment and care based on the individual competence of all healthcare professionals to deliver spiritual and religious care. Through the evaluation of a pilot study to familiarize staff with the Spiritual and Religious Care Competencies for Specialist Palliative Care developed by Marie Curie Cancer Care, the authors conclude that competencies are a viable and crucial first step in ‘earthing’ spiritual care in practice, and evidencing this illusive area of care.
Gen Hosp Psychiatry, Vol. 26, No. 6. (c 2004), pp. 484-486.
Despite the plethora of research linking spirituality, religiosity and psychological well-being among people living with medical illnesses, the role of afterlife beliefs on psychological functioning has been virtually ignored. The present investigation assessed afterlife beliefs, spiritual well-being and psychological functioning at the end of life among 276 terminally ill cancer patients. Results indicated that belief in an afterlife was associated with lower levels of end-of-life despair (desire for death, hopelessness and suicidal ideation) but was not associated with levels of depression or anxiety. Further analyses indicated that when spirituality levels were controlled for, the effect of afterlife beliefs disappeared. The authors concluded that spirituality has a much more powerful effect on psychological functioning than beliefs held about an afterlife. Treatment implications are discussed.
Palliative care practitioners are now better able than ever before to ameliorate end-of-life symptom distress. What remains less developed, however, is the knowledge base and skill set necessary to recognize, assess, and compassionately address the psychosocial, existential, and spiritual aspects of the patient’s dying experience. This review provides an overview of these areas, focusing primarily on empirical data that has examined these issues. A brief overview of psychiatric challenges in end-of-life care is complemented with a list of resources for readers wishing to explore this area more extensively. The experience of spiritual or existential suffering toward the end of life is explored, with an examination of the conceptual correlates of suffering. These correlates include: hopelessness, burden to others, loss of sense of dignity, and desire for death or loss of will to live. An empirically-derived model of dignity is described in some detail, with practical examples of diagnostic questions and therapeutic interventions to preserve dignity. Other interventions to reduce existential or spiritual suffering are described and evidence of their efficacy is presented. The author concludes that palliative care must continue to develop compassionate, individually tailored, and effective responses to the mounting vulnerability and increasingly difficult physical, psychosocial, and spiritual challenges facing persons nearing the end of life.
