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A philosophic analysis of the spiritual in nursing literature Pesut, Barbara Kay


Over the past several decades an impressive body of theoretical and empirical literature has been published on the spiritual in nursing. Members of the profession are increasingly claiming an ethical responsibility to pay attention to the spiritual in the context of care. Yet, various, and often contradictory, positions are being taken on the conceptualization of the spiritual. The purpose of this work is to investigate and clarify the various conceptualizations of the spiritual and spiritual care in nursing literature; to discuss the implications of these conceptualizations for nursing's ontology, epistemology and ethics; and to argue for a particular approach based upon the moral and pragmatic nature of nursing. I survey key literature on the spiritual in nursing and organize this literature using the philosophic categories of theism, humanism and monism. Through a hypothetical dialogue, I ask questions about these various perspectives, exploring the implications for nursing's ontology, epistemology and ethics. I then make arguments for how the spiritual should be approached. First, I argue that nurses should not expect agreement on the conceptualization of the spiritual. Rather, the focus should be on understanding and incorporating the worldviews that characterize spirituality in society and promoting dialogue among those worldviews. Second, I challenge the assumption that a normative body of knowledge about the spiritual should be part of nursing's disciplinary expertise. The nursing role in relation to spirituality should not be characterized as one whereby nurses assess and intervene in the spiritual lives of patients. Instead, nurses seek to understand and create a space for the expression and development of patient's spirituality. Nurses enter into a spiritual relational space where the spiritual "work" is often characterized by mystery and where the benefits of the encounter flow just as readily from patient to nurse as from nurse to patient. Finally, I use the Canadian Nurses Association's Code of Ethics for Registered Nurses to illustrate how the ethical conduct of spiritual nursing care can be evaluated. Responsibilities of guarding against coercion, ensuring patient confidentiality, promoting reflection about nurse's own positioning in relation to the spiritual and serving the needs of a diverse society provide a foundational starting point for providing ethical spiritual care.

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