I did something wrong.
I did something wrong.
The differences between these two sentences is the difference between shame and guilt. To illustrate, let me tell you a story.
One day, my parents left me and my two brothers alone while they went to a Christmas party two doors down. We were given strict instructions to finish the TV program we were watching and go to bed in one-half hour. I must have been 7. My brothers were 9 and 5.
All of three of us had the intention to go to bed. Truly we did. Until all three of us heard a carton of Neapolitan ice cream calling to us. In no amount of time, all three of us went to the freezer and carved up the ice cream. There were three brothers and three types of ice cream. My older brother would eat all the chocolate, my younger brother would eat all the vanilla, and I would eat all the strawberry. We thought it was a great idea. We didn't even fight about who got which type.
It would have all been fine, too, if my mother and father had not come home.
But they did.
They explained in no uncertain terms their disappointment in us and the consequences of that event. Needless to say, my brothers and I never did that again. We laugh about it now. In fact, we tell each other that story quite easily. We all have stories like this. Stories that say, "I did something wrong."
We also have other stories that make us feel shameful. These are the stories that make us feel we were what was wrong. That we are the error. "I did something wrong," becomes "I am something wrong." These stories are so powerful that we want to run away and hope no one finds out what we did. Shame can cause obsessive thinking, blowing the story out of proportion. We start to believe that no one will be able to forgive us.
Shame does not have to be caused by something big. Shame can be a reaction to a little event, like stealing Neapolitan ice cream.
We all feel shame sometimes. We feel it so intensely at times it affects our health. The mind-numbing qualities of over-eating, over-working, drinking too much, smoking too much, watching TV too much all are caused by a desire to hide from shame.
Yet this does not have to be. This is the most powerful message of this holiday season. Whichever tradition you follow--Christian, Jew, Muslim, Buddhist or something else--this season is here to remind us that shame has no part in our lives. The breath we take demonstrates that we are essentially good and worthy.
Shame does not have to have a hold on us. There is forgiveness for all things and all wounds. Even stealing Neapolitan ice cream.
My best wishes to you during this holiday season.
Place is too important of a word to have just one meaning:
Know your place.
Save my place.
Win, place, show.
Your place or mine?
My place in the world.
We all come from many places but all our places, whether they are a physical, social, or emotional place, is connected to our spirituality. Knowing even one of our places helps to understand spirituality.
Where you are born influences spirituality immensely. I was born in Topeka, Kansas. Kansas brings many things to mind—farm background, conservative, Christian, large family, never been to the big cities on the coast. Knowing my place of birth helps you to understand my spirituality. The only problem is most of these stereotypes do not fit me. I may have started there, but I am not in Kansas anymore.
Other places, physical, social, and emotional, have caused growth and change. I am in a different place then I was. The same is true of all us and all of our patients.
Nursing is a profession that deals with people from a plethora of places. We deal with people from Uganda to Utah, Christian to Muslin to Hindu to Buddhist to atheist, young to old, male to female, and everything that does not fit our categories. Each person we deal with has a different viewpoint, a different spiritualty—all from different places.
Differences create conflict. When we think that we understand a person's place, we interact in certain ways that can be wrong. Miscommunication, anger, and embarrassment all occur when we react as if a person is of one place but they are of a completely different one.
It is not hard to believe that there is value in understanding a person better. However, in practice, when such offense occurs, what do you do?
This brings us to the most important place of all. A place of forgiveness. Place influences many parts of ourselves; not just the spiritual. Forgiveness is primarily spiritual. This special place is essential to nursing.
Forgiveness is not forgetting what a person has done or what has been done to you. Nor is it approving any action. Forgiveness is releasing an experience from the stranglehold it has on our ability to think and feel what we need to think and feel.
Forgiveness is the ability to start again.
A spiritual writer once said that God is paradox.
In healthcare, spirituality is the response to the demands made by multiple points of view. This is especially true when these points of view conflict.
When faced with a point of view different than our own, fear is a natural reaction. Since fear cannot deal with complexity, our fearful reaction causes us to stereotype the other person. Stereotype stops any constructive conversation.
Think of an emergency department nurse who reads "back pain, needs meds" as the reason for the patient's visit. These words cause an internal, unconscious, and immediate self-dialogue. It is as if the nurse has two voices in her head speaking to one another. One is named Fear and the other is Stereotype. After reading the reason for the patient's visit, the two voices engage in this type of dialogue:
Fear: "'Back pain, needs meds.' I hate these kinds of people."
Stereotype: "I bet she's a drug seeker, just like that other patient who tore into you that one time."
Fear: "Do you really think she's like that guy? I can't handle someone like that today."
Stereotype: "You better rip her a new one before she even gets a word out."
Fear: "Good idea."
Keep in mind—this dialogue happens in an instant, on the way to the room, before the nurse even sees the patient.
The reason for such self-dialogue is paradox. Patients come to the ED looking for drugs. We, as healthcare professionals, don't prescribe things that hurt patients. Therein lies the paradox—a patient wants something and we don't want to give it. This paradox causes Fear and Stereotype to shut down communication.
The reality is only SOME patients come to the ED looking for drugs. Without spirituality, our thinking does not allow room for SOME. It is all or nothing.
Spirituality is the only way to break this cycle. With spirituality, our fear loses control and we can enter the room allowing the patient to be an individual.
This fact becomes extremely important when we think of how many paradoxes there are in healthcare. People refuse immunizations when we say they should get them. People smoke when we tell them not to. People refuse chemo when we think it will cure them. And on and on. We haven't even mentioned paradoxical views of nurses and doctors, nurses and administrators, or even those between ourselves.In all these cases we have a choice—do we respond to such situations with spirituality or with fear and stereotype?
Nurses have a strong sense of the interconnectedness of life. This appreciation enables us to use spiritual understandings of the everyday tasks of nursing to stay connected with the meaning of our work. Take eating, for example. Many of us have handed out trays, started and monitored TPN, or documented alterations in nutritional status. These tasks have a hidden vitality which we can overlook.
I picked up a book by Yaykov Levinson, a Jewish nutritionist, called The Jewish Guide to Natural Nutrition and was reminded of the importance of food. Levinson says that all foods contain "sparks of holiness" mixed in with other ingredients. Levinson points out that awareness and appreciation about food brings us closer to these sparks of holiness.
To demonstrate this view he describes the food chain similarly to what I write below:
A corn seed is planted in the ground. Levinson would say that God put a "spark of holiness" in that corn seed. This spark of holiness uses the water from the rain and the energy from the sun to break through the earth and grow. From this spark comes an ear of corn.
This ear of corn is fed to an animal, like a cow or pig or chicken. A human then consumes the meat. First the human chews the meat into small pieces, which are then swallowed. Stomach acids break down the food into small components so that they can pass into the small intestine. In the small intestine the food is further broken down and is transported to the bloodstream. The bloodstream takes the food to the liver, where it is further broken down and placed back into the bloodstream to go toward individual cells. From the stomach to the cell, the food has gone through a remarkable transformation.
The corn is broken down to proteins, fats, carbohydrates and vitamins. These are broken down into even smaller parts, such as amino acids and glucose. Eventually the food becomes ATP or adenosine triphosphate. All cells use ATP to power their work by breaking certain chemical bonds, which create sparks of energy. Levinson points out that these sparks of energy are sparks of holiness.
The energy which God supplies from the seed, the sun and the rain has a direct connection to every cell. When we feed a patient, we are providing them not only physical nutrition but also with sparks of holiness to feed their soul.
Amos Tversky and Daniel Kahneman are two economists devoted to answering the question, "Why do people make the choices they do?" They delineated several cognitive biases, such as framing effect, which attempted to explain a person's non-rational behavior. Tversky and Kahneman's theory was a giant leap forward over older theories which saw people as machine-like.
For example, Tversky and Kahneman posited that when people are satisfied with their health, they are risk aversive. People are more frightened of losing something and will not take risks even if there is a great probability for gain. This explains why a smoker who has no known health problems continues to smoke. The smoker believes any change is a risk and will not take that risk unless their health satisfaction changes. This makes intuitive sense. I have seen many smokers finally quit after a spot has been found on their lungs.
However, many people change behaviors without a change in health status. A 2013 Gallup poll said that only 5% of smokers who quit did so for health reasons. 48% who successfully quit did so, because they just decided it was time (Newport, 2013). Where did the impulse come from and how did the impulse to make such a change sustain itself?
I now make this assertion—such change comes about because of spirituality. By definition, God or the higher power provides motivation from a source that is above physical and mental sources. Spirituality is not just something we do on church on Sunday but a source of motivation.
Others may say we just don't understand enough YET to explain such changes. I would offer a different question. Suppose spirituality is true, completely true. There is some form of power greater than ourselves that affects health behaviors. Then it is completely possible that some people stopped smoking because of spirituality and not for any other reason. If this is true, then how can we use it as health professionals to make health changes?
I know the first step. We have to talk to our patients about spirituality. We must be unafraid to explore this topic and advise patients to use spirituality and meditation when we give them care. I would like to hear from you about this. How do you use spirituality in your practice?
Newport, F (2013) Most U.S. Smokers Want to Quit, Have Tried Multiple Times, Gallup. Retrieved on Aug 3, 2016 from: http://www.gallup.com/poll/163763/smokers-quit-tried-multiple-times.aspx
"Is the glass half full or half empty?" is an often asked question. What is not often asked is how do you feel about your glass? Do you mourn the loss of half of your water, or are you happy to have as much water as you do? What are you willing to do to gain back the other half of your glass?
These are not meaningless questions. Rather, this is very important. Pretend the glass is actually a measure of health status. How would a patient feel if they had half of the health they had 10 years ago? How would this perception change if...
- The patient just finished a 5-year fight with breast cancer?
- The patient was 100 years old? 20 years old?
- The patient refuses to give up smoking 3 packs per day?
As you can see, how a patient feels about the level of liquid in their glass depends on their reference point. This idea has been well researched by Tversky and Kahneman and many others.
What has not been so well researched is how spirituality affects these reference points. Changes in reference points can have dramatic effects in important health decisions. It seems to me that the most important effect of spirituality in healthcare is in how people make decisions and find the energy to carry out these decisions.
Others may say that miracles are the most important aspect of spirituality in healthcare. We have all heard stories of people diagnosed with incurable cancer one day and then are miraculously cured the next. While these stories are not to be disregarded, I prefer to explore ways that spirituality can be replicated in a more predictable fashion.
In my diet class, which uses spirituality to help people plan what they eat (described in a previous column), a woman who weighed 280 pounds (BMI above 39) for years came to the class. She worked the program for 2 months and lost 8 pounds. One weekend, she went to several parties and gained back the weight. Her only statement to the class was, "I know I can lose this weight now, because I have done it. I am not discouraged." This is a change for her. She shared this experience with others in the class, and they felt hopeful. Her reference point changed through spirituality.
Next month I will talk more about Tversky and Kahneman and spirituality.
Read this quote below first as a caregiver and then as a scientist and we will see the debate about spirituality in the scientific literature
"This is the first resting-state fMRI study demonstrating altered functional connectivity in the DMN among meditation practitioners. In the current study, meditators showed heightened activation of the DMN in the MPFC. This finding is consistent with previous studies that have reported that structural and functional changes in the medial prefrontal areas are associated with meditation." (Jang et al, 2011, page 358)
Wow! What a mouthful. Real people don't talk this way. The abbreviation DMN is the Default Mode Network which is the area of the brain that supports "internal mentation" or thinking that is not concerned with the outside world. It is the area stimulated with self-reflective thoughts. It's the part of the brain associated with self -esteem and self-image.
The quote basically says that meditation changes your brain-not just lowers blood pressure or heart rate.
Direct care givers will say, "At last validation." Studies such as this are part of the growing proof that spirituality works.
On the other hand, scientists will say, "Remember statistics class?" This study involved only 35 people and a control group of 33. Respectable sample size but you don't change treatment guidelines over such numbers. Many scientists are concerned that such studies will be used to justify treating illness ONLY with prayer and medication. Direct care givers will respond to this by saying spirituality is one of many treatment modalities that work.
We have fallen into a debate where one side says "Medication not Meditation" and the other says "Meditation and Medication."
This debate is a rabbit hole if we think we have to fall on one side or the other. As caregivers and scientists we must guard against forcing our subjective experiences onto our patients when we don't have objective support. At the same time, we use all kinds of treatments which do not have double blind random controlled studies for support. So the question is: how do we more fully integrate spirituality into treatment and do so in a responsible and ethical manner?
We have to be both scientist and direct caregiver and pray we have the strength and integrity to perform both roles at the same time.
It is an old axiom in psychology that beliefs are important to health. Beliefs are the assumptions upon which we build our lives. Beliefs shape how we make decisions. Decisions determine our actions. Our actions bring us results. Results create the life we lead.
If we are dissatisfied with the results of our life-if we are not happy-then we spend a great deal of time trying to change our actions but not the beliefs. I have seen that strategy fail more often than not.
- Outside the clinic we have a bus bench. Frequently men will be on that bench sharing a bottle from the local liquor store. The men will say "I'm gonna get me a job so I can buy nice things."
- A few weeks back a young man who smoked 4-5 blunts of marijuana a day, told me, for the second or third time, he was going back to school to learn a trade.
- Every week we see people who struggle with weight who say they are going to eat less desserts tomorrow.
All of these people focus on their actions not their beliefs. They are trying to change what they don't like about their lives by changing their actions. Frequently, they fail and with failure they tell more lies. "I wasn't ready yet. I will change next week." It's not their actions which is the problem. It's their beliefs.
Now, let me be completely honest. We all have issues with our beliefs. All of us tell ourselves little lies that allow us to engage in actions which are not healthy. Some frequent lies we believe include:
- It is only a quick text; I can still drive.
- I really don't need my blood pressure medicine
- I will exercise next week.
- I have got the patch so I can give up smoking later.
- I know he(she) will change.
It is at this level that prayer and meditation are effective. Many of the beliefs we have are old, unconscious and central to our being. The practice of prayer and meditation calms the brain and open us up to change.
Imagine, being in your health practitioner's office and hearing your blood pressure is so high it will kill you. Imagine just for a moment what would go through your mind. What are all the things you would miss? Who would you leave behind? In that quiet time right after hearing such news, you are questioning long held assumptions. New actions can finally happen on a long term basis because the basic beliefs are changing.
Lately, there are movies like The Hunger Games that take place in an alternative universe with unlikely heroes who strive against impossible odds. Nursing history is the ultimate alternative universe filled with heroes who strive against impossible odds. Yet our history actually happened.
Susie King Taylor was such a hero. She was born into slavery in Georgia and escaped to freedom when the Union army overran Fort Pulaski in Savanah which, along with other battles amongst the coastal islands in Georgia and the Carolinas, created havens for the war "contraband". Contraband was the polite word for escaped slaves who would no longer help the Southern cause.
Mrs.Taylor married her first husband, Edward King, at this time and followed his regiment the First South Carolina Volunteers of African Descent, later renamed the 33rd United States Colored Troops. She worked as nurse for the next 3 years. Her life would have been forgotten if she had not written her memoir in 1902. "Reminiscences of My Life in Camp with the 33d United States Colored Troops, Late 1st S.C. Volunteers" is available by searching Google.
Today the history of nursing centers around women like Florence Nightingale and Clara Barton, who certainly did much to earn their place in our memory. However, history is made by many people, not just like people such as Florence History involves the hardworking talented unsung heroes who slog through day to day doing what needs to be done. These heroes are often people you would least expect. They are people who, despite the incredible odds and hardships, accomplished much good in the world. They are people like Mrs. Susie King Taylor. They are people like you and me.
Mrs.Taylor said she wrote her life story to "show how much service and good we can do to each other, and what sacrifces we can make for our liberty and rights, and that there were ‘loyal women,' as well as men, in those days, who did not fear shell or shot, who cared for the sick and dying;"
Perhaps this is the most important message from Nurse's Week. In this time when there are threats to our liberty and when there are still shells and shootings, we can hope there are loyal women, as well as men, who still care.
I work at a North Omaha Area Health, a free clinic run by two RNs, which free health screenings for everything from HIV to diabetes. We work in the 3 zip codes that have the largest STD rates in the country. In an effort to promote health we offer a diet class through a program called the North Omaha Academy of Healthy Living which integrates spirituality into health behaviors. We offer free 8 week classes in several locations.
We integrate spirituality by identifying decision points about eating and use prayer and meditation to improve health decisions. We do this in a very practical real world way.
For example, we recommend that people spend time in prayer or meditation in the morning and then plan what they will eat through the rest of the day. This period of quieting the brain and using this space to make better health decisions works. People are better eaters when they plan. After each meal people are asked to quietly consider what they just ate and write it down.
We also recommend that if a person gets hungry during the day and are reaching for a Snicker's bar, they quiet themselves with more prayer and meditation and listen. They should then ask if they really want to eat anything. If so, then they should eat-even if it is the Twinkie. We are not worried about over eating as much as encouraging conscious food decisions.
At the end of the day, we ask people to spend more time in quiet. After this period of quiet they should review what they ate during. WITHOUT guilt they should assess how they did and ask what they learned.
In offering this method we explicitly state we do not support one denomination or religion but expressly state that the use of prayer and meditation can be used to make better health decisions.
his program makes use of many well-known and researched weight loss strategies. The only thing new is the addition spirituality. It is like combining biofeedback and My Fitness Pal. And it works. he average participants lose 6 pounds in our 8-week class. A pilot study we just completed showed that participants keep off the weight for up to 6 months.
One participant, who was skeptical, said that "God does not care if I eat a Twinkie." She tried the method and is 10 pounds lighter.
Nursing is focused on Evidenced Based Practice. More so now than in any other time in our history, we look to research and the scientific method. You may think these methods fail us when we study spirituality. Can you imagine being a peer reviewer and being assigned an article entitled "God and Cholesterol: An underused intervention" I can just see the description of the research protocol. "A group of volunteers were randomly assigned to two groups--God and Not-God. The God group was exposed to God twice a day for 15 minutes with the Not-God group receiving general counseling only with all contact with God blocked. In a 6 week follow up the God group had a 15.7% lowering of LDL (p <0.013) and a rising of HDL 4.5% (p < 0.01) than control." Nah, I don't think so.
It would be a big error to think that religion and spirituality are completely separate from research. There are research methods that can be used to examine religion and spirituality and guide its use in health care. Harold Koenig, MD from Duke University, has done some excellent work in this area. In a 2012 review article in Psychiatry he searched databases for articles researching the connection between religion/spirituality and health. In the 128 years between 1872 and 2000 he found 1200 articles. In the next 10 years he found 2100 studies--almost double the number of articles. He grouped these articles together according to their effects on mental health, health behaviors and physical health.
A majority of articles showed that religion and spirituality had positive influences on mental health including positive influences on depression, stress reduction, coping with adversity, sense of purpose, and happiness. Religion and spirituality also had positive influences not only on health behaviors such as cigarette smoking, exercise and healthy diet but also on physical health such coronary disease, cerebral vascular functioning, cancer and mortality.
I would encourage you to read this article (Koenig HG. (2012) Religion, spirituality, and health: the research and clinical implications. <http://www.ncbi.nlm.nih.gov/pubmed/23762764> Psychiatry Dec 16;2012:278730. doi: 10.5402/2012/278730) though his other work is well worth reading. In this article, in his conclusion section, Koenig acts only as an objective scientist. He states that the effects of spirituality and religion can be measured using normal scientific methods and explained using normal psychological and physiological processes WITHOUT resorting to supernatural explanations. In other words, the effects of religion and spirituality do not rely on the existence of a supreme being.
Depending on your own personal beliefs, this may confirm to you that belief in a supreme being is superfluous or you may see this as an attack on your beliefs. I have neither reaction. Rather, the effects of spirituality and religion are independent of my own beliefs and will continue long after I have shed this mortal coil but until that time, it is important for health care professionals to look at spirituality and religion as a way to help our patients. In the next column, I will discuss how my clinic integrates spirituality into its weight loss program.
You can CAT scan a broken bone or a diverticula. You can scope a cardiac vessel in real time and watch the blood flow. But a change of character-from helpless to hopeful, from addict to recovery, from smoker to non, from overwhelmed with chronic pain to a person who copes well-is something that nurses know exist but which we cannot measure. Character, how you act on a long term basis, is the part of your personality that is most difficult to change.
In this day of evidenced based medicine, which I fully support by the way, measurement is supreme. Yet a change in a person's character is something that that only causes wonder. I can tell you some of the events that make change of character possible such as:
- When someone realizes that they need to change their behavior or die
- When a compassionate health care provider asks the right question at the right time
- When a person finally experiences a little bit of success in making an improvement
- When a person finally gets tired of living the way they do.
Yet for every event that may promote a change of character in one person it will have no effect on 10 others. I suppose if I could predict such a change I could just as easily learn how to put this change in a bottle and sell it in Walgreens for $1 a pill taken by mouth.
Yet in the last week of my practice a women who has struggled with obesity celebrated losing 10 pounds, an alcoholic went to treatment, a patient with high blood pressure is taking all her meds on time and giving up smoking. Their character changed. And though I was, by their own report, instrumental in their character change, I would not have predicted that it would have been them to undergo this change.
I used to wrack by brains to get some scientific explanation of these changes of character. I never even came close. I guess a person's character is rooted in something unscientific like their spirit and not their brain. Maybe some changes are not measurable.
So I guess I can only try and do what I usually do and enjoy the ride. All in all not a bad gig.
On a cold night before exploratory cancer surgery a woman cries....alone with her fears. A night nurse going by, hears the brief tearful sniff of fear and goes into the room. It is as if the night nurse understands without having to ask. She goes over to the patient, touches her hand and says, "It'll be alright."
This type of interaction will not be found in any of billions of the new ICD10 codes. Many researchers will scoff at the power of such an interaction....at such a touch. Yet any nurse who has been the embodiment of hope for a patient implicitly knows what this night nurse knew. No matter what the surgery finds "It'll be alright."
As you read the above paragraph perhaps you are remembering a time when you were that night nurse. The unit may have been different, the time of day changed, the patient someone else but you can recall it now. And if such a moment occurred 10 or 20 or 30 years ago you can recall it as if it was yesterday-the time you were the night nurse.
Playing this role for other is the essence of spirituality. In fact, it is the biggest single reason for spirituality. The ability to share hope despite all the rational and scientific evidence to the contrary. Though others may doubt or call it wishful thinking, nurses know the truth which boldly proclaims that there is something else, something more powerful out there somewhere that can make a difference. We know this because we have seen it in our patients.
When we see the hope of our patients, we begin to learn that we also can have such a hope. When faced with our own doubts, demons and fruitless self-questioning we can have the same belief that "it'll be alright." Some theologians call this radical amazement.
This should not be confused with the phrase "self-esteem" which has been trivialized to nothing more than affirmations repeated over and over. In this country, with billions of self-help books and shallow personal advice shows, if talk alone could create self-esteem we would have such a surplus we could export it as a cash crop.
No, this radical amazement is obtained in the trenches of life. Illnesses, financial crisis, failures of family and friends, and the numerous other challenges anyone faces create the opportunity for us to discover this hope. Most of the time what happens in these challenges was not the end we had wanted. Yet despite that, and maybe because of it, we survive and find ways to thrive the crisis.
And in the darkest times, when we are crying in our room alone, someone or something comes and touches our hand and whispers "It'll be all right." And we believe. Our Night Nurse has come.
As of today, I am not one of the 2350 men who will get breast cancer this year. The only man that I have seen who had breast cancer was a heavy marijuana user (not a risk factor they tell you about in Colorado.) Yet I have been affected by this illness. A non-English speaking woman asked me to attend her weekly chemo treatments when she was getting substandard care. Several friends have been affected as well. So what does this type of experience cause me to write about- the spirituality which surrounds this disease.
I mean real spirituality not the hallmark card type of spirituality that you see on TV. In those shows, breast cancer patients are spiritual giants, unfazed by death, and caregivers have all the time in the world. Reality is much messier and interesting.
During the weekly chemo treatments I attended, I noticed that it was easy for nurses to slip into a business as usual mode where each chemotherapy patient merged into another. It was clear that it took an effort to treat patients as individuals with their own demands and frustrations. A nurse's normal everyday tasks are once in a lifetime occurrences for our patients. Being able to keep this patient perspective in mind, despite the thousand little tasks we do every day, is made possible only by a spiritual attitude. Caregivers have a variety of ways to express spirituality-prayer, meditation, reading and journaling all help us to quiet our busy mind. The nurses who were able to care for my friend, not as another chemo patient but as a person, all seemed to have this spiritual attitude in common. It was both a credit to our profession and challenge to me.
A friend of mine, in the middle of her chemo therapy regime, made it a point to ask me about my family. She was genuinely interested in what was happening in my life despite all that was happening in hers. I have had similar experiences with other breast cancer patients. Somehow, they were not so fixated on their life that they could not be interested in my mundane life. It was as if being unselfish somehow made their pain easier to bear. Hmm, an interesting thought occurs to me. Maybe I have been trying to do the same with my whole nursing career.
What have been your real experiences with spirituality and breast cancer?
Defining spirituality can be done in such a way that it does not raise controversy. If I define spirituality as "Whatever is not the mind and the body", everyone could agree on this definition but it would be totally useless and frankly silly.
Spirituality is important. Therefore, as with anything important, definition creates controversy. For some, spirituality is centered on a place, like Mecca, or a book, like the Torah. Some reject organized religion or a deity and look for a definition inside themselves. For researchers, spirituality must be measured. How often do you go to church? How often do you pray? For others, measuring spirituality kills it.
In the nursing literature some have argued that health care occurs in a public space that is particularly secular and that all the effects of spirituality can be explained with psychology. Others argue for a Christian Western perspective linking spirituality to a particular religion. Others argue that we must honor diversity and not mention religion, as if spirituality excludes religion.
All these points of view come to bear when you attempt to define spirituality. As soon as you put one definition forward, someone will say "What about this?"
But let me give it a shot. An old story about nurses helped me define spirituality. The Nurse Midwives in Exodus Chapter 1, Shipporah and Puah, successfully resisted Pharaoh's Command to commit genocide because of their "Fear of God."
The original word used for Fear of God is "Yirah." Yirah can be translated as "God's Perspective". These Nurse Midwives saw their problem from God's Perspective and used this point of view to engage and work through an insoluble problem. For me, spirituality has two characteristics -perspective and engagement which flow from a relationship with a Supreme Being. I define spirituality as that which enables me to see the world from God's Perspective and gives me the courage and hope to use that perspective to work through the insoluble problems I face as a nurse.
My definition gives me enough confidence to accept and encourage diverse opinions and yet still be able to use spirituality in my practice without timidity. While I don't have a blood test for spirituality, I have seen its effects in patients and co-workers and think this definition accounts for what I have seen.
Spirituality is best discovered through story. Share a story with us that illustrates your definition of spirituality.