Araceli Ocampo Balabagno, PhD, RNProfessor

College of Nursing, University of the Philippines Manila

GREETINGS

Nurses create healing, holistic, humane,and caring environments in the workplace.

“Engaged Spirituality: A Nurse’s Search for Meaning”

Plenary Session Objectives

To discuss spiritual / moral challenges /issues faced

by operating room nurses in their professional

practice.

To explore methods/ ways to deal with said

challenges for personal and professional growth.

Outline of Presentation

REFLECTIONS : Beliefs and values, spirituality, meaning, and

purpose in life as a nurse

SPIRITUALITY : Definitions, framework in nursing research

SEARCH FOR MEANING

SPIRITUALITY AND FINDING MEANING IN THE WORKPLACE

TEST YOURSELF: ethics audit &

your personal & professional values [Tappen, 1995]

Personal Values. The most important thing in life is to decide what is important.CHECK the values that “jump out” because of their importance to you. CIRCLE your top 3 values. Feel free to add values if needed.

Truth Persistence Integrity Dependability

Efficiency Sincerity Peace Trust

Initiative Relationships Loyalty Excellence

Power Flexibility Security Teamwork

Courage Commitment Love Service

Competition Recognition Fairness Friendship

Creativity Learning Spirituality Profitability

Happiness Honesty Self –control Justice

Innovation Originality Stewardship Quality

Obedience Prosperity Adventure Hard work

Financial growth Respect Humor Purposefulness

Trigger Question

THE PURPOSE OF LIFE IS A LIFE OF PURPOSE

“Billions of people live their lives daily , but only a few have any sense of purpose or ideals to drive them. And that can be one of the biggest issues many are facing.

If you are without a purpose, you have no wheels,

you just go with the flow, which can be a problem

not only for you, but for other people you deal with.

Life seems like a puzzle with missing pieces. You form plans and change them, you choose one path, then another, you try to find the right partner and career, hoping that you have made the right decision, and that it will all work out. At some point, you ask yourself the central question:

“What is the purpose of my life?” “.BR Osorio, Business Life, The Philippine Star, Monday June 20, 2016

Who is the “client” this time- the nurse?

“Where am I ?”

“What do I love to do?”

“What am I called to do?”

It brings to mind a nurse searching for meaning in life, something that eases the soul.

At one point – we nurses can be seen as clients aiming for spiritual health, for spiritual well-being, for wellness and wholeness, seeking to understand the connection of body, mind and spirit.

NURSES TOO, NEED HOLISTIC CARE, NURTURED

SPIRITUALITY: RELEVANCE TO NURSING

“That caring for the whole person – including one’s spiritual

needs – has been the heart of nursing discipline since its

founding” Nightingale

“Improving the health and well- being of the whole person

(mentally, physically and spiritually) has been the heart of

nursing since its inception”

Benefit : fostering resilience and improve health.

Reinert & Koenig, 2013, 2625

Looking at definitions of spirituality in nursing research

(Reinert and Koenig, 2013, 2623)

_ “elements of positive emotional states

( meaning, purpose, general well-being )

which confound mental health outcomes”

_ “conceptualizations of spirituality can be

influenced by one’s culture and

philosophical backgrounds, which

may be religious and secular”.

Looking at definitions of spirituality in nursing research (Reinert and Koenig, 2013, 2623)

Spirituality is a personal search for meaning and purpose in life, which maybe or may not be related to religion”.

Note: that lack of meaning and purpose is a symptom of mood discorders, such as depression and anxiety (American Psychological Association).

“Bias” : when the goal is measuring emotional

well-being as an outcome, the definition

above may be with “bias”- makes the

psychological outcomes indistinguishable

from the concept of spirituality.

Reinert KG & Koenig HG (2013). Re-examining

definitions of spirituality in nursing research. JAN

Data bases : MEDLINE, CINAHL: 1982- 1991 (3 articles PubMed); 1992-2001 (167articles); 2002-2011(489articles)

Nurses as primary authors : 20 articles

(1) To identify nursing articles on spirituality and health outcomes

(2) To evaluate methods and measures by primary nurse authors

Recommendations: TO DEFINE SPIRITUALITY IN THE CONTEXT OF RELIGIOUS INVOLVEMENT, WHEN CONDUCTING RESEARCH,

WHILE USING A BROADER DEFINITION WHEN PROVIDING SPIRITUAL CARE.

Reinert KG & Koenig HG (2013). Re-examining

definitions of spirituality in nursing research. JAN

RELIGIOUS INVOLVEMENT contains constructs, such as religious coping, intrinsic religiosity, religious attendance and religious support (Koenig, et al, 2012)

Serves as psychological support for coping with stress and trauma (Pargament, 1997, Koenig, 2013)

INTRINSIC RELIGIOSITY – has been used as a proxy for spirituality

That spirituality in nursing research should be measured in religious involvement, as a proxy to “intrinsic religiosity” construct.

CONCEPT ANALYSIS: process ro study the construct or phenomena

Reinert KG & Koenig HG (2013). Re-examining definitions of

spirituality in nursing research. JAN. DEFINITION

“ SPIRITUALITY is distinguished from other things – humanism, values, morals, and mental healh- by its connection to the transcendent.

The transcendent is that which is outside of the self, and yet also within the self – and in Western tradition is called God, Allah,.. or Higher Power and in Easter tradition is called Ultimate Truth, Buddha..

Spirituality is intimately connected to the supernatural and religion, although extends beyond religion (and begins before it)

Spirituality includes the search for the transcendent..”

EVIDENCE-BASED DEFINITIONS: Ackley BJ,

Ldwig GB, Swan BA & Tucker SJ (2008). Evidence-based nursing care

guidelines: medical surgical interventions . Mosby Elsevier.

(NIC) SPIRITUAL GROWTH FACILITATION

Facilitation of growth in the patient’s capacity to identify,

connect with, and call upon the source of meaning,

purpose, comfort, strength, and hope in his/her life

(Dochterman & Bulecheck, 2004).

(NIC) SPIRITUAL SUPPORT

Assisting the patient to feel balance and connection with

a greater power (Dochterman & Bulechek, 2004)

EVIDENCE-BASED DEFINITIONS: Ackley BJ, Ldwig GB, Swan BA & Tucker SJ (2008). Evidence-based nursing care

guidelines: medical surgical interventions . Mosby Elsevier.

OUTCOME MEASURES

SPIRITUAL HEALTH (NOC) connectedness with

self, others, higher power, all life, nature, and the

universe that transcends and empowers the self.

EVIDENCE-BASED DEFINITIONS: Ackley BJ, Ldwig GB, Swan BA & Tucker SJ (2008). Evidence-based nursing care

guidelines: medical surgical interventions . Mosby Elsevier.

SPIRITUAL HEALTH INDICATORS:

Meaning and purpose in life

Ability to pray

Ability to worship

Spiritual experiences

Participation in spiritual rites and passages

Participation in meditation

Participation in spiritual reading

Connectedness with inner self

Connectedness with others Moorhead et al,2004

Sutopo D (2007). Spiritual Care Interventions and Quality of

Life Among Patients with Advanced Cancer. The UP College of

Nursing Researh Bulletin, Issue No. 5, 2000-2008

PREMISE : That spiritual care interventions will improve the HQOL of patients with advanced cancer.

Nurses who provide spiritual care put them at the bedside (nurse presence) close to the patients who are suffering from spiritual distress.

INTERVENTION: Spiritual care intervention protocol: Bible reading, prayer, religious music, nurse presence; 20-30 min per session; 3 consecutive days

METHOD Pretest and post test design

N 69 (Study n 32; Control n37) Setting : government, tertiary hospital

RESULTS

Mean age 47 years (SD 11.5); more males (61%); married (81%); most expressed not having enough family income (68%),

_reported 1-2 times church attendance per week (75%);

_ 1-2 times per day prayer (72%).

Sutopo D (2007). Spiritual Care Interventions and Quality of

Life Among Patients with Advanced Cancer. UP CN Researh Bulletin,

Issue No. 5, 2000-2008

RESULTS:

The structured presence of the nurse at the bedside provided situations for listening, interaction and encouragement to patients.

The experiences narrated were beneficial in expressing their feelings: _renewal of faith _increased faith_peace _increased self-esteem and hope.

Spiritual care interventions significantly affect spiritual well-being and

3 dimensions of HQOL: overall QOL , overall physical well-being ,

overall emotional well-being

SPIRITUALITY AND MEANING

“MEANING” – the thing that is conveyed especially by language

“MEANINGLESS”- having no meaning, lacking in signifcance

* Mosaic Bible, NLT Dictionary &

Concordance.p1272

Story of meaning

Ezra reads the law . Ezra stood at the platform in full view of the

people. When they saw him open the book, they rose to their feet.

They read the book of the Law of God and clearly explained the

meaning of what was read , helping the people understand the

passage. And they had great joy in their hearts.

Nehemiah : go and celebrate with feast of rich foods and sweet

drinks , and share .. with people who have nothing prepared’’

celebrate with joy because they have heard God’s word and

understood them.

Old Testament (Nehemiah 8: 1-12)

Story of “meaning” and “meaninglessness”

Everything is meaningless, says the Teacher,

completely meaningless. Ecclesiastes 1:2

Fear God and obey His command for this is

everyone’s duty. Ecclesiastes 12:13

It appears that the teacher abandoned any hope in

wordly pursuits and decided that glorifying God

provides the only lasting meaning in life.

Solomon in Ecclesiastes (Old Testament, Holy Bible, KJV)

Stevens, Paul (2016). Bible Exposition “Healthy Lives in a

Broken World: A Christian Nursing Response”NCFI. DAP, Tagaytay,

2016 June 6-10

“Nursing is a scienific profession and a sacred calling ”

SPIRITUALITY – springs from the fundamental fact of a

GOD who loved us first.

Spirituality is identification of will of GOD.

Spirituality is our response, a path, a process, never

finished.

Spirituality relates to our experience of work.

The workplace is a major centre for spiritual formation

It is were we spend most of our waking hours

Dover LV & Pfeiffer J (2011). Patients of parish nurses

renewed spiritual identity: a grounded theory study. JAN

Report of a study of the process that patients of

parish nurses experience when they are provided

spiritual care in Christian churches, a context where

patients and nurses share a common set of values.

The focus of study on grounded theory is each

patient’s whole experience in receiving spiritual

care.

Dover LV & Pfeiffer J (2011). Patients of parish nurses renewed spiritual

identity: a grounded theory study. JAN

“CONTEXT FOR RECEIVING SPIRITUAL CARE”

FACING HEALTH

CHALLENGE

FINDING A SAFE PLACE

RELEASING BURDENS

TELLING PAINFUL STORY

BEING ACCEPTED

BEING UNDERSTOOD

RELEASING

FOCUS ON SELF

CHANGING PERSPECTIVES

JOINING / REJOINING THE FAMILY: moving on with God &

sharing the journey

CONTEXT OF RECEIVING SPIRITUAL CARE:

searching for a safe place and releasing our burdens

TRIGGERING SCENARIOS

Spiritual distress

Facing health challenges: hopelessness

Personal and professional issues*

Ethical dilemma*

Brokenness ( Healthy Lives in a Broken World, NCFI, June 2016)

Suffering

Family conflict

Health related issues

Disappointments

Catastrophies

Spirituality and searching for meaning in the

workplace

DAILY MEDITATION

Use Spiritual Meditation Exercises LOE ll

In a controlled study of 2 experimental groups and 1 control

group of 84 college students, both experimental groups

participated in a spiritual meditation exercises

– both groups experienced signficantly less anxiety, and more

positive mood, spiritual health, spiritual experiences, higher pain

tolerance (Wachholtz & Pargament, 2005).

Ackley et al, 2008

Spirituality and searching for meaning in the

workplace

DAILY MEDITATION

Grounded on relationship with God

Process : time alone with God’s word –early morning, cue cards,

memorization, reflective reading, praying

Challenge: “what keeps me from focussed meditation”: pre

occupation with other activities, misplaced priorities

“My Response” : What is one step that I need to commit today

to focus on God’s word.

Spirituality and searching for meaning in the

workplaceCOMPASSION

Nurses apply holistic care : body , mind, spirit

“Soul” – refers to the person – body, mind, spirit

When we touch the patient – we touch the person’s

soul

When we talk – we touch the person’s soul

Desire to alleviate the suffering; deep feeling of

sympathy

“How is my heart today?” – the expressive, kind

heart.

Spirituality and searching for meaning in the

workplace

GENTLENESS and LOVINGKINDNESS

Mildness of manners and disposition*

“Since God chose you to be wholly, you must clothe yourselves

with tenderhearted mercy, kindness, humility, gentleness,

patience” ( NT. Colossians 3:12)

“Carry them in your bosom, as a nurse carries the sucking child,

to the land which thou dids’t swear to give their fathers.”

(OT. Numbers11:11-12)

“..but we were gentle among you, like a nurse taking care of her

children” (NT.1Thess2:7)

Spirituality and searching for meaning in the

workplace

RESPECT FOR PEOPLE

the most fundamental universal principle

_ simply: meeting the needs of patients and next of kin in a

considerate way

_receiving , giving support and information within the work group

_ retaining the essence of nurses who “live caring”

_ nurture meaningful relationships, foster honest dialogue, and

role model caring.

Spirituality and searching for meaning in the workplace

FORGIVENESS

Promote Forgiveness as Indicated LOE VI

Descriptive study surveying 186 undergrad students

identified forgivess as being associated with less physical

and psychologic distress (Younger et al, 2004)

Forgiveness therapy , adapted cognitive-behavioral

therapy, with religious focus, prayer, meditation, and

12 -step fellowship recommended as spiritual interventions

(Harris et al, 1999).

Ackley et al, 2008

Spirituality and searching for meaning in the workplace

FORGIVENESS

Acquittal or pardon of sins*

Atonement, mercy*

“There is forgiveness of sins for all who repent”

Luke 24:47

Spirituality and searching for meaning in the workplace

PRAYER

Use prayer as a method of coping with adverse symptoms as appropriate. LOE V

A qualitative study of 15 chronically-ill patients identified spiritual coping mechanisms as reaching out to God in the belief and faith that help would be forthcoming, feeling connected to God through prayer, meaning and purpose, strategy of privacy, and connectedness with others. (Narayanasamy, 2002).

Ackley et al, 2008.

Spirituality and searching for meaning in the workplace

PRAYER

Conversation with God, in praise, thanksgiving, or intercession.*

Answer me when I call you, O God who declares me innocent, Free me from my troubles, Have mercy on me and hear my prayer (Psalm4:1)

Jesus prayer of thanks giving (Matthew 11:25). Lord’s prayer.

Jesus said, “ Come to me, all of you who are weary and carry heavy burdens, and I will give you rest.

Take my yoke upon you. Let me teach you because I am humble and gentle at heart, and you will find rest for your souls. For my yoke is easy to bear, and the burden I give you is light.” Matthew 11: 28-30).

Spirituality and searching for meaning in the workplace

Daily meditation

Compassion

Gentleness and lovingkindness

Respect for people

Forgiveness

Prayers

SPIRITUALITY – springs from the fundamental fact of a GOD who loved us first.

Spirituality is our response, a path, a process, never finished.

I leave you these pictures.I trust you find meaning in this brief encounter on sprituality and meaning in the workplace.Thank you.

References

ACKLEY BJ, LADWIG GB, SWAN BA & TUCKER SJ (2008). Evidence-based nursing care guidelines: medical surgical interventions . St. Louis. Missouri : Mosby Elsevier.

Dover LV & Pfeiffer J (2011). Patients of parish nurses renewed spiritual identity: a grounded theory study. Journal of Advanced Nursing

Reinert KG & Koenig HG (2013). Re-examining definitions of spirituality in nursing research. Journal of Advanced Nursing.

Stevens, Paul (2016). Bible Exposition on “Being Health-Giving Ministers”, “Having a Kingdom Heart”, “Developing Kingdom Spirituality”, Nurses Christian Fellowship International Congress. “Healthy Lives in a Broken World: A Chriistian Nursing Response”. DAP, Tagaytay, 2016 June 6-10.

Tappen RN (1995). Workplace Ethics, Chapter 4. Nursing Leadership & Management, 4th Ed. Philadelphia: F.A. Davis Co

The Bible : King James Version

The Mosaic Bible: New Living Translation