Spirituality and Coping with Loss

End of Life Healthcare Practice

Wendy Greenstreet

• Publisher: Routledge
• Year: 2017
• Print ISBN:
  9781138454439
• eBook ISBN:
  9781498767859
• Topic: Medicine
• Subtopic: Health Care Delivery

Spirituality and Coping with Loss: End of Life Healthcare Practice describes a research study that reflects nurses' experience of the nature of loss encountered in end of life care settings as well as the ways in which spirituality is a resource in coping in these situations. Key findings indicate how nurses' spiritual development impacts their proficiency in spiritual care. These findings will be of interest to nurses and nurse educators as well as other healthcare professionals.

PART 1

SETTING THE SCENE

My interest in spirituality as a concept relevant initially to nursing practice and more recently health and social care, was triggered by practical need. The 1980s had seen changes in the nursing curriculum, embracing a more holistic focus on care, and had incorporated the social and psychological needs of patients alongside the very well-established focus on physical care. However, it was not until 1990 that the curriculum included patients’ spiritual needs as a constituent of holistic care. An evaluative study of the effectiveness of my teaching spirituality in the pre-registration programme followed. This provided evidence that progression in achieving learning after theoretical input on spirituality was largely sustained on evaluation 18 months later. I went on to find post-registration students, studying the human experience of disability, avidly interested in spirituality as a concept concerned with meaning and making sense of situations. They readily related to issues concerning ultimate questions in which patients wanted to know ‘why’ disability had happened to them.

Later, I undertook postgraduate study of psychosocial palliative care, which was followed by my development of curriculum that included modules on loss in post-registration and postgraduate programmes. Significant loss challenges our assumptive world and potentially creates a spiritual crisis,¹ in generating a search to make sense of unwanted change that has been thrust upon us. The questions asked by those living with chronic and terminal illness have a similar ring to the questions explored by those post-registration nurses considering spirituality and the human experience of disability. Collectively these experiences have brought me to this research, to gain a better understanding of spirituality in relation to coping with loss in situations of advanced chronic or terminal illness.

REFERENCE

1. Agrimson LB and Taft LB. Spiritual crisis, a concept analysis. Journal of Advanced Nursing. 2008; 65(2): 454–61.

1	Introduction: the point of the study

This book gives an account of a study situated in the South East of England, and explores practising nurses’ experience of spirituality as a resource in end of life care. Coping in end of life care situations often involves both a sense of loss as well as actual loss. Although my experiences as an educationalist brought me to this research, the justification for the study was grounded on more than practice experience and personal interest; it was also congruent with government policy on healthcare development.

Hospice care is accessible to a minority of patients and almost exclusively to those with cancer. The Department of Health working paper on end of life care strategy¹ reflected an increasing emphasis on the need for the principles of care exemplified in hospice to be made available to those with advanced chronic and terminal illness in all settings. The working paper acknowledged that many patients had unmet spiritual and psychological needs, and that their carers had similar needs, both during the patient’s illness and in bereavement. It also predicted that the emergent End of Life Care Strategy would need to focus not only on ‘what’ should be done but also ‘how’. The End of Life Care Strategy² that followed ratified these proposals in aiming to bring high-quality care to all people approaching the end of life, and proposing that this should be available both at home and in institution settings. Further affirmation was evident in the strategy’s 10 objectives, one of which specified that all those approaching the end of life have access to physical, psychological, social and spiritual care.

AIM AND OBJECTIVES

The aim of the study was to explore nurses’ lived experience of spirituality as a means of helping patients to cope with loss associated with terminal or chronic disease. The study objectives were threefold. First, to gain an understanding of nurses’ perceptions of spirituality as an aspect of person-centred care, second, to explore the extent to which nurses facilitate spirituality as a source of coping, and finally, to explore how nurses use their personal resources in caring for those with chronic and terminal conditions. Research participants were recruited from community, care home and hospice settings where these patients are cared for.

Central to the concept of spirituality in healthcare is a concern with, and an attempt to make sense of, circumstances and outcomes of illness. In situations of loss, whether associated with chronic disease, degenerative disease or terminal illness and bereavement, individuals seek to know: why? Questions of meaning are likely to be complex. In linking past research on spirituality in healthcare with studies on loss and bereavement associated with professional roles, this study furthers knowledge of nurses’ responses to spiritual questions and how they apply these to their professional practice.

RESEARCH DESIGN

A study that links spirituality and coping in healthcare contexts is suited to a qualitative research design in its attempt to discover nurses’ experience, and thus generate an understanding of their roles in this aspect of care. Phenomenology is a qualitative methodology in which meanings are a key to the study of an individual’s experience.³ The association of the concept of spirituality with a search for meaning⁴ sits well with the phenomenological stance that experience is one of interrelated meanings which collectively constitute the world as we know it, our ‘lifeworld’.

The style of phenomenology used as methodology is determined by the stance the researcher takes in the study. Descriptive forms of phenomenology require the researcher to attempt to put aside all knowledge and experience they have of the phenomena that are the focus of their study in order to describe the experience of participants without being influenced by their own preconceptions. On the other hand, interpretative forms of phenomenology accept that the knowledge and experience of the phenomena which are the focus of study have influenced the researcher’s choice of study and will influence their interpretation of participant experience. Spirituality is such an integral part of us, core to our very personhood,⁵ that consequently any attempt to try to step outside of our experience of this phenomenon is unrealistic. Therefore, Chapter 2 addresses the particular form of interpretative phenomenology chosen as the approach best suited to this study.

Interpretative forms of phenomenology require that I explain my situation in relation to the research topic and its participants. In this way, I remain conscious of how my previous knowledge and experience influence my interpretation of data. For this reason, Chapter 3 presents a literature review that reflects the synthesis of my scholarship and experience prior to this research.

How and why research participants were identified through purposive sampling of nurses involved with end of life care in hospice, community and care home settings within South East England is explained in Chapter 4. Exclusion criteria included acute settings, practice contexts where patient throughput is rapid, and those outside of South East England. The size of the sample was determined by the number of participants interviewed until adequacy of data was reached. Interviews obtaining descriptions of participants’ experience of spirituality in relation to coping with loss were the primary means of data collection. The use of a topic guide helped direct conversation toward the phenomena studied, and resulted in interviews being designated as semi-structured.

The stepped approach to analysis of data described in Chapter 5 closely reflects the scheme of Smith et al.⁶ and provides a tool to address the process of engaging with, and interpreting the meaning of, the ‘lived experience’ documented in the transcripts of semi-structured interviews with the participants. This process starts by looking at one transcript and then moving on to the others one by one. The emergent themes are then listed to facilitate the analytical or theoretical ordering necessary to elicit connections between them. Some consideration of reflexivity and analysis of my diary documenting reflection on the research process is also included in this chapter.

FINDINGS AND IMPLICATIONS

Study findings are addressed in two sections. Part 2 comprises chapters that consider the impact of loss as a context of care. Part 3 contains those chapters which examine the impact of the process of care on nurses’ proficiency in spiritual care. The implications of these findings for education and practice are addressed in the chapters that constitute Part 4.

SUMMARY

There are an increasing number of studies that consider spirituality in healthcare and how patients’ spiritual needs can be recognized and fulfilled. However, this study provides a different perspective. In particular, it illuminates what and how nurses contribute to these aspects of care in situations of loss, in both institutional and community settings. It also considers how nurses, as professional carers, cope with their own existential questioning in the face of others’ suffering

REFERENCES

1. Department of Health. Working Paper End of Life Strategy. London: Department of Health, 2006.

2. Department of Health. End of Life Care Strategy: Promoting High Quality Care for All Adults at the End of Life. London: Department of Health, 2008.

3. Ashworth P. The origins of qualitative psychology. In: Smith JA, editor. Qualitative Psych...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• About the author
• PART 1 SETTING THE SCENE
• PART 2 IMPACT OF LOSS AS A CONTEXT OF CARE
• PART 3 THE IMPACT OF PROCESS OF CARE ON NURSES’ PROFICIENCY IN SPIRITUAL CARE
• PART 4 IMPLICATIONS FOR EDUCATION AND PRACTICE
• Index