Mary Nathan MSc
Reported by Dr. Gillian Broster
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Mary Nathan trained in general nursing, midwifery and in
mental health. She has nursed in Nigeria and served as a General
Nursing Council examiner. Currently she holds the post of Research
and Practice Development Nurse in the Ealing, Hammersmith and
Fulham Mental Health Trust. The study described here forms part of
what is to be a larger multi-centred study. Mary has a deep concern
with spiritual care in mental health practice.
Mary began by explaining that the study had two objectives. The
first was to explore patients' and nurses' perceptions and views on
spiritual care. The second was to elicit whether or not mental
health nurses feel sufficiently competent to assess and provide
spiritual care to their clients. This was a descriptive study,
which took place on an acute mental health unit. Eighty-eight
qualified mental health nurses participated, coming from a range of
ethnic origins, including Afro-Caribbean, Black African, Caucasian,
Asian and others. Their religious backgrounds were diverse.
The nurses were asked a wide range of questions. They were also
asked if they had any training or qualification in spiritual care.
Data Analysis was by SPSS, the Statistical Package for Social
Sciences. Findings from the nurses' questionnaires showed that:
- There was a lack of clarity with the concept of
spirituality.
- Spiritual care was strictly defined as meeting the patients'
religious needs.
- Spirituality is not clearly featured in the curriculum or
taught during, or after, training.
- There was no clear view as to who should be held responsible
for this area of care.
- Additional comments were made that training should be provided
and that there should be a working definition and guidelines for
practice.
Nurses were asked to give their own definitions of what was
meant by spiritual care. The following are some examples of answers
given:
- Attending to patients' religious needs.
- Form of care directed exclusively towards the soul and its
function as a link between the mind and body.
- The care that promotes a sense of belonging and offers
alternative coping skills.
- The care that provides peace, hope and faith in God.
- Helping patients to identify their own spiritual needs.
- The care that is concerned with the esteem needs of the
individual.
- Provision of meaning and hope to lean on, to help with moving
on.
- Allowing patients to talk about death and dying.
- Looking after the thing that keeps a person going.
- The provision of that which, in addition to the necessities of
life, provides a framework for the person's life.
The majority of nurses thought that spiritual care was to do
with religion in some way.
In the patient sample, which numbered thirteen, 54% were male
and 46% female. They came from a range of religious backgrounds.
Diagnoses included paranoid schizophrenia, bi-polar disorder,
alcohol dependence and schizoaffective disorder. Some had attempted
suicide. The duration of illness was from 1 year to 25 years and
the age range was from 20 - 55 years.
Examples of questions that were asked were:
- What does spiritual care mean to you?
- Should it be provided in the hospital?
- During a stay in hospital were you provided with some form of
spiritual care?
- Would you have benefited if it had been offered?
- Who should provide spiritual care?
- Do you think spiritual care is as important as other forms of
care?
As with the nurses, all patients equated spiritual care in some
way with religion. Here, the emphasis seemed to be on harmonious
communication - the patients wanted help to understand their
illness. Mary gave examples of patients' definitions of spiritual
care:
- Spiritual care is talking with patients about God.
- Spiritual care is in loving your neighbour as yourself.
- Spiritual care is assisting those who are weak and need
help.
- Spiritual care is 'like the Good Samaritan stuff'.
- A longer definition given was, 'Spiritual care is when you are
weak someone gives you strength, when dirty someone cleans you up,
when hungry someone gives you food, when thirsty someone gives you
drink, when confused someone stays by your side, when wanting to
end your life someone gives you hope, when frightened someone calms
your fear, when no-one cares about you someone holds your hand and
gives you a smile."
Mary then discussed the story of the Good Samaritan (Luke 10:
30-37). The priest did not stop, neither did the Levite, but it was
the Samaritan, who was of a lower class, a person looked down upon,
who actually helped. In the parable, it was the one who belonged to
no particular religious group who was the person to do everything
for the man who had been attacked and had fallen by the wayside.
This was what patients meant by spiritual care.
Mary went on to say that the main source of the world's ills was
lack of love. There are two basic qualities, which define us as
human beings, sharpness of mind and kindness of the heart. She
mentioned Mother Teresa in this respect who has said that the
biggest disease of today is not TB or leprosy but a lack of being
cared for and loved.
Mary contrasted the patients' definition of spiritual care with
that of the nurses'. Nurses related spiritual care to religious
care, whereas patients related spiritual care more to qualities of
life and recovery. Points highlighted were helping patients find
meaning in their experiences by listening to them when they express
their concerns, and supporting them to talk through their problems.
Patients wanted to feel accepted, that they belonged and were safe,
were valued and loved. Practitioners should treat patients with the
respect and dignity as individuals and fellow human beings that
they themselves would like to be shown. What is important is
recognising and respecting patients' values and religious beliefs
and providing the necessary resources for these needs.
Both patients and nurses had made additional comments. Patients
thought it was important to dispel the myth that any forceful
religious expression is a sign of madness and emphasised that
everyone needs spiritual care. They wanted the opportunities and
resources to express feelings appropriately and to make
contribution to the society through structured work or leisure.
More staff and activities were needed.
Nurses commented that training in spiritual care should be
arranged as part of continuing education and that spiritual care
should be included in the care plan of patients. However, they
thought that spiritual care should be provided by the priest. Some
were unsure of what spiritual care was and even thought spiritual
care could increase patients' delusions. Another comment made was
that 'this is an acute admission ward, not a church' and that if
clients needed spiritual care they could request to see the priest
of their faith.
In sumMary , Mary pointed out that patients' perceptions of
spiritual care differed significantly from that of the nurses.
While the patients associated spiritual care with religion, all the
patients regarded spiritual care as more encompassing than mere
religious practice. Patients described spiritual care holistically
and related it strongly to their quality of life and recovery. By
contrast, nurses described spiritual care as referring to the
religious needs of the patients and were unclear who should be
responsible. Nurses demonstrated a lack of confidence and expertise
regarding spiritual care but did express an interest in undertaking
training when provided.
Research implications were that this study needed replicating in
other mental health care settings. There was the question of
whether specialist practitioners in spiritual care should be
trained and if so, how to commence training and how to provide
prophylactic and therapeutic spiritual care.
Discussion
It was thought important to tease out what is meant by
spirituality and what is meant by religion. It was pointed out that
the General Medical Council states that it is appropriate for
doctors to share their religious beliefs with patients so long as
it does not put pressure on the patient. One way of looking at
spirituality is that it is not encapsulated but underpins all we
do. Care and compassion should be at the basis of all our work. Did
we need to define spirituality if we are going to be able to
investigate it? The chair reminded the meeting that in setting up
the Spirituality and Psychiatry Group, it had been decided that
spirituality should not be tightly defined. Some people believe
that 'spirit' is priMary and we are spiritual beings in physical
bodies (hence survival after physical death) while others hold that
spirituality carries no such implication. Mary warned against being
so restrictive in our definition of spirituality that we become
like the priest or Levi in the Good Samaritan and pass by on the
other side of the road! The discussion closed with the comment from
the chair that both perspectives were important. Sometimes the big
existential questions of life and death have to be faced. Other
times the need was simply for compassionate care, when a person
might be feeling lost and alone.
