Contexts of Nursing: An Introduction
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Discount code already used. It can only be used once. Presence was the most influential element in enhancing the life-giving force of spirituality and positively influencing recovery [ 24 ]. The presence of family and friends was a calming experience that brought forth comfort and peace [ 24 ]. Presence was not only physical but a deep felt fellowship on a metaphysical or transcendent spiritual level, which brought forth a sense of peace, happiness, joy and hope [ 24 ]. In this type of presence, there is an intimate connection, a sense of awe, love and acceptance.
Such presence can arise in any situation or context with a person, pet or in nature where there is a strong transcendental connection [ 28 ]. Finding balance involved introspection, reframing, adjusting , facing the challenge, prayer as well as choosing to avoid negative thoughts related to the body, mind and spirit [ 28 ]. This exemplifies spirituality in the religious and existential or universal sense. It does not only involve a relationship with others but also with oneself , something within a person, without which life would not be worth living [ 27 ].
Finding meaning in life involved contextualizing health conditions by reflecting on the purpose of life or by outlining life goals and personal philosophies [ 21 ]. Finding the meaning of life was a dynamic, individual process that changed moment-to-moment and day-to-day events. It involved weighing the risk versus benefit, processes versus outcomes, good versus evil by means of introspection and reflection [ 28 ].
Spirituality as manifested in nature was expressed as the joy of seeing grass and trees and the desire to go for walks [ 26 ]. Those who were unable to walk wished to look at the trees surrounding the garden and to have flowers from the garden in their room. Patients reported the need to read inspirational texts several times each day or to sing and listen to music [ 26 ]. Several personality traits and attitudes were characterized as self-affirming: flexibility, hardiness, belief in self, determination and resiliency [ 21 ]. Spirituality was characterized as an inner force that provided insights into how to reduce anger , bitterness and fear in order to maintain a positive outlook [ 30 ].
According to Walton [ 23 ], spirituality creates inner strength and courage by providing the energy to face the next step in life, which leads to a sense of wellness and has a positive impact on health. A prerequisite for spirituality is a relationship characterized by mutuality, trust, ongoing dialogue and enduring presence.
When ministering to patients, caregivers struggled to establish spirituality b y creating a balance between the holistic and biomedical perspectives. It was the connection to the place of silence that enabled caregivers to acknowledge the hope and fear inherent in caring. Resting in a place free from fear facilitates genuine human connection, where presence with the patient can be felt and deepened [ 22 ]. Spirituality in caring was described as an invitation, encountering the patient as a unique person [ 31 ].
According to Tirgari et al. Active listening requires nurses to be fully present , especially when patients appear depressed or upset [ 31 ].
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Spirituality in caring therefore involves the ability to build confidence by listening to or just being with the patient [ 33 ]. In caring , confidence implies self-awareness, being non-judgemental and consistent as well as able to identify patient needs. This requires putting aside personal needs to avoid dominating the spirituality in the caring process [ 25 ].
It involves one human being responding to another with genuine understanding, openness and warmth [ 33 ] and encompasses patience, compassion, loyalty and honesty [ 23 , 33 ].
Spiritual commitment develops into a meaningful notion and merges with sympathy, conscientious care, commitment and devotion [ 34 ]. Caregivers with this approach described caring as enjoyable and preferred it to the higher status of a more senior position [ 34 ]. Caregivers who took this perspective valued patient wellbeing more than their own, mainly because they regarded providing care as a form of worship. Such spiritual love and affection maintained an energetic approach to nursing [ 34 ]. A close relationship was important and touch was used to provide comfort in situations characterized by anxiety and physical pain [ 31 ].
The meaning of spirituality was described as caregivers encountering patients as cultural beings [ 31 ] , which involved allowing them and their family members to express their feelings. Engaging in spiritual matters comprised beliefs and values that gave meaning and worth to existence [ 27 ]. According to Tanyi et al.
According to Walton [ 28 ], a desire to help others in need is an important part of spirituality, which is also described as a life-giving force based on faith, discovering meaning and purpose in life and offering the gift of self to others [ 24 ]. Seeking balance in life involves everyday choices as well as setting goals and moving beyond personal requirements to those of others [ 28 ].
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The need to contribute by helping to care for others is important, even in cases where the other is sick and close to death [ 26 ] as it is an expression of love, compassion and altruism [ 27 ]. Helping others also brings a sense of self-worth, personal fulfilment and satisfaction [ 28 ]. Patients at the end of life described a need to view their life, which was subject to an ongoing revision process [ 21 ].
Reviewing life evoked happy thoughts and helped them to understand why things happened as they did, despite at times experiencing profound unhappiness [ 26 ].
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It was important to undertake things one had wanted to do such as going on trips and carrying out tasks, for example making funeral arrangements in order to find peace before death. Taking one day at a time represented an expression of spiritual value and had they not done so, they would have been unable to manage [ 26 , 30 ]. Children were important at the end of life, as they were a reminder that life goes on and that another generation has hopes and dreams.
Despite poor appetite it was important to join family members for meals [ 26 ]. Engaging in spiritual matters indicated personal transformat-ion comprising a change of life direction and a new way of thinking. Spiritual engagement included prayer and was perceived as powerful, uplifting and helpful [ 27 ]. This integrative review attempts to describe experiences of the positive impact of spirituality and spiritual values in the context of nursing.
It is difficult to draw any firm conclusions on the basis of the results, as spirituality comprises many perspectives at different levels of awareness [ 11 ]. However, the results revealed that spirituality was viewed as inclusive, fluid and personal. In the context of nursing, demands on caregivers are heavier when they have to provide insights into spiritual matters during encounters with patients.
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According to Carson [ 36 ], the development of spirituality is a dynamic process in which a person becomes aware of the meaning, aim and values of life, including all relationships. It requires openness and sensitivity on the part of caregivers and becomes visible in virtue ethics [ 37 , 38 ]. In virtue ethics, the human being is viewed as a whole, comprising body, mind and spirit.
However, the authenticity of the human relationship is important, as in the absence of authenticity, there can be no humanity.
In such meetings spiritual values are fundamental, unlike encounters where the caregiver views the patient as an object, thus excluding spiritual values. The findings demonstrated that in an environment where spirituality can grow, the meeting between the caregiver and patient involved two subjects in a relationship of togetherness.
Human beings try to alleviate their suffering in different ways [ 39 ]. In the present study, patients with various types of serious illness described how they attempted to alleviate their suffering by creating meaning, manifested as a new inner spiritual attitude that helped them to reconcile themselves with their changed life situation and prepared them to meet the fate that awaited them.
Spiritual values in the creation of meaning included building a source of energy, development and hope linked to mutual giving and taking, helping and being helped. It is the release of a spiritual force that pulls the person along in a movement out from the self.
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This integrative literature review provides an overview of some of the knowledge in the field of spirituality and spiritual values in the context of nursing, although it is possible that some relevant studies may not have been included given the limitations of this review [ 17 ]. Another weakness is the different meaning of the concepts of spirituality and spiritual values used in the analyzed articles, which contain no definition of the terms.
Clarification of these concepts and values was therefore challenging, which should be kept in mind when criticizing this review. Because of the limitations and inconsistencies in the findings, additional research is needed to clarify the meaning and definition of spirituality and spiritual values in the context of nursing. The concepts of spirituality and caring were perceived as having the same meaning and no difference between them was reported.
However, it was obvious that spirituality and spiritual values in the context of nursing are closely intertwined with the concept of caring. A caring attitude, spirituality and spiritual values belong together and should be the guiding inspiration for all nurses.
It is the responsibility of nursing leadership and the organization to ensure that this is achieved. We are grateful to University West for financial support as well as Gullvi Nilsson and Monique Federsel for scrutinizing the English language. GR is the main author and responsible for the study conception as well as the design of the introduction and method sections.