“Holistic nursing practice is about healing the whole person, explicitly recognizing and addressing the interconnectedness of body, mind, emotion, spirit, society/culture, relationships, context, and environment” (American Holistic Nurses Association 2008).This type of practice does assist people to find the much needed well being. It looks at an individual as a bio-psycho-social-spiritual being and therefore every aspect of one’s life is considered during provision of nursing care. Holistic nursing practice starts from the time a patient presents her/himself to the nurse for nursing care and ends when the patient is well. It does not only entail that which has brought the patient or that which has made the patient to seek nursing or medical care but all factors that are involved in the patient’s behavior to seek nursing assistance (AHNA, 2008; Frisch, Dossey, Guzzetta, & Quinn 2004). Spirituality is a wide notion that integrates values, meaning, and purpose. Emerging nursing modalities incorporates spirituality straightforwardly in terms of human needs. The rationale of nursing care is not only to ensure that clients are free from illness but to assist clients in health or illness, to use the power within them as they progress towards advanced level of consciousness. Hakim (2005) sates that:
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“Nurses must be aware of their own spirituality in order to assist others in fulfilling their spiritual needs” ( p. 102). It is the duty of nurses to incorporate holistic care that includes spiritual care into their nursing practice. The model of providing spiritual care is gotten from nursing theories that define human beings as bio-psycho-socio-spiritual beings. It is worth noting that spiritual care has been underutilized by nurses. The nurse is best placed to provide comfort and spiritual care especially to those patients suffering from chronic illness as they are always concerned with issues of spiritual, rather than physical. According to Tewodrose, (2007, p. 278), nurses are normally acknowledged by patients during their preliminary sphere from their admission into a health facility and they should be able to address spiritual issues comfortably. Tewodrose further explains that spiritual care may take the forms of scripture reading, prayer or just reassuring the patient that God is listening, caring and loving. Hakim (2005, p. 16) further states that: “…meditation, guided imagery, art and music or calling a long lost friend as important aspects of spiritual care” (p.419).
He strongly believes that in order for a nurse to provide spiritual care, he/she must be knowledgeable in spiritual matters, possess good communication skills and must have empathy. According to Hakim, a patient’s spiritual needs are gotten during patient nursing assessment and documentation on the nursing care plan. The nurse has to identify the following: patient’s notion of God/deity; the patient’s source of hoe and strength; the patient’s connotation of religious practices; and the patient’s beliefs on the interaction between their state of health and spiritual beliefs. From these, the nurse’s role can therefore be grouped in four dynamic phases which are self comfort, assessment, intervention, and evaluation (Jagole, 2006, p. 6).
Clinical Placement Experience
During my clinical placement in gynecology and obstetric ward, I had an experience that changed my understanding of spirituality as part of holistic nursing care. One of the patients I was assigned to provide Jane Mark, a 38 year old female diagnosed with uterine cancer stage IV meaning that the cancer had metastasized to other organs and parts of the body; her diagnosis was a bit late. She was put on different treatment methods such as chemotherapy, radiotherapy, analgesics and had several surgeries performed on her and the last one being a total hysterectomy. Mrs. Jane was suffering from chronic pain as a result of the cancer for a period longer than three months. In her file and the available documents, there was no evidence of nursing assessment on her spiritual needs. The holistic part of the assessment was not also captured in the initial assessment on her admission. This showed me that her spiritual needs were not met at all; this could have been may be because the nurse who did the initial assessment didn’t appreciate the importance of spirituality or because the nurse did not have the much needed knowledge on spirituality as part of holistic nursing care. This was a challenge to me and many other students. This is an area that has to be improved; taking into consideration and giving clients the needed spiritual care. This can only be done through addressing the different factors affecting or hindering the provision of spirituality by nurses.
Improving the Provision of Spiritual Care and Spirituality
There has been a lot of debates on whose job spiritual care is, this was well demonstrated by Handzo and Koening (2004) in their work titled ‘spiritual care: Whose job is it anyway?’ where they noted that despite the fact that many health care providers acknowledge that they should be aware of patient’s spiritual needs as these needs may help in the healing process, there is still lots of debate generated by them on who should assess a patients spiritual need and provide spirituality. This showed that there is confusion on spirituality and these hinders provision of spiritual care. Many research studies have been carried out to show areas to be improved and others to create an understanding of the role of nurses in provision of spiritual care. In a study carried out by Shirahama et al (2001) with the main objective of exploring the concept of spirituality and its expression among persons in a Japanese farming community suggested that in order for nurses to provide harmonious spiritual care, they need to increase their knowledge base and understanding of spirituality, incorporate spirituality in their nursing care, and to improve communication skills.
In yet another study that was designed to explore clients opinion on spirituality and of the nurse as a spiritual care provider by Cavendish et al (2006) in which semi-structured questionnaires were used with a sample size of 8 adults who were aged 21 years and above who had been discharged from health institutions within the past three months showed that patients do not view spiritual care as nurses role and therefore did not share their spiritual needs with nurses. The researchers concluded that nurses need to be aware of a patient’s spiritual needs in order for them to provide spiritual care in the context of holistic care. Cavendish et al (2007) carried out another study to determine pastoral care providers’ attitudes on nurses as spiritual providers. The study results showed that pastoral care providers perceive nurses as spiritual care providers with few feeling comfortable initiating collaboration.
From this, it is important for nurses to collaborate with other professional who are specialized in spiritual care as this will greatly improve the quality of holistic nursing care. In another similar study carried by Theis et al (2003) which examined spirituality in 60 caregivers and care receivers had varied findings with implication for nurses being collaborating with the clergy to support the spiritual needs of both care givers nurses included and care receivers/patients. Knowledge deficit is a major factor that hinders provision of spiritual care by nurses; this can be reversed by ensuring that spirituality is incorporated in nursing education. In 2007, Lovanio and her colleagues carried out a study to test and develop a student focused spirituality education model among nursing students. Educational strategies such as a half day educational presentation as well as the incorporation of presence, prayer, reminiscence, and chapel visits into resident care were implemented. The results of the study showed that the model was beneficial and should be disseminated more widely. The incorporation of spirituality in nursing education is very important in helping nurses to provide quality spiritual care. These studies have demonstrated and shown areas that nurse needs to improve on in order to improve quality of spiritual care.
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Holistic nursing care views humans as bio-psycho-socio-spiritual beings and therefore holistic care must include spiritual care at all times. Spirituality as a component of holistic nursing care is very vital in the process of healing. Nurses play an important role in patient care and they spend most of their time with patients. Their understanding of spirituality is therefore an integral part in provision of spiritual care. Nurses are in a good position to provide quality spiritual care yet they are hindered by several factors ranging from knowledge deficit to negative attitudes. These hindrance factors can be reversed through collaborating with other professional who are specialized in spirituality, in-service training on spirituality and spiritual care, being aware of patients need by performing spiritual needs assessment, acquiring of proper communications skills, identifying spiritual care as part of their role and developing positive attitude towards spirituality and spiritual care.
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