The language of spirituality: an emerging taxonomy
Introduction
It is evident that the term ‘spirituality’ has become fashionable within nursing. Books and articles regularly appear exploring this subject. The increased interest may be due to the notion of holistic care, however reference to spirituality is often anecdotal or rhetorical (Turner, 1996; Emdon, 1997; Hall, 1997; Wright, 1997; Ross, 1997; McSherry, 2000). The emerging literature is rather prescriptive suggesting that nurses should be providing spiritual care without really defining what is meant by the term (Narayanasamy, 1993; McSherry, 1996; Emdon, 1997; Hall, 1997; Wright, 1997). This activity signals an attempt to educate health care professionals about spiritual matters. However, the definitions and recommendations, rather than bringing clarity, add to the confusion that surrounds the term ‘spirituality’. This may originate from the fact that definitions are often based on individual interpretation and understanding rather than on empirical evidence. There is also an assumption that nurses and patients understand what is meant by the word when the contrary may be true (McSherry, 1997; Markham, 1998). A review of contemporary definitions suggests that there may be no common understanding of the concept of spirituality. It seems that we could have a term—‘spirituality’—but no common set of defining characteristics of the term that are universally transferable or recognised.
Section snippets
Background
Spirituality has become a highly salient term, not only in relation to nursing and health care, but within society at large (MacQuarrie, 1972). Within health care attention has turned to the provision of holistic care, that is, care for the individual's physical, psychological, social and spiritual dimensions (Buckle, 1994; Woods, 1998; Narayanasamy, 2001). As a result several documents have been published, educationally (United Kingdom Central Council for Nursing, Midwifery and Health Visiting
Aims
This paper seeks to show that the term ‘spirituality’ as used within nursing is problematic and in danger of becoming meaningless. It is proposed that attempts to establish a universal definition of spirituality may be theoretically and culturally impossible (McSherry and Draper, 1998; Markham, 1998; Draper and McSherry, 2002). It is argued that contemporary definitions of spirituality are not culturally sensitive in that the descriptors used may not be relevant to all nurses and patients, for
Method
A search of the electronic data bases, CINHAL, MEDLINE, EMBASE was undertaken spanning the period of 1985–2002. The words ‘spirituality’, ‘spiritual care’, and ‘spiritual dimension’ were used to identify literature in English. Because of the vast amount of literature available only those works that provided a definition were included in the review. Manual searching of the literature was also undertaken. This review, while extensive, did not include all the definitions of spirituality identified
Religion: its historical influence
When undertaking a philosophical analysis of a word such as ‘spirituality’ it is useful to trace its origins (Narayanasmay, 1999; McSherry, 2000). It is recognised that the Judeo-Christian heritage and influence in the United Kingdom (UK) and other parts of the world, has been an important factor in shaping cultural and attitudinal norms (Smart, 1969). By plotting nursing's heritage one can recognise that this has been influenced by principles from the Judeo-Christian tradition. This is evident
Emerging taxonomy
This review suggests the word spirituality could be described as a ‘cocktail’ because it contains a mixture of components of varying strengths and flavours. This is evident in the work of Narayanasamy (1991, p. 3; 2001, p. 3) who provides a litany of possible variables that may be associated with the term spirituality. However in the second edition of Narayanasamy's work the notion of a God does not feature in the revised list. Therefore, conceptually it appears there are several underlying
Using abstract terms
The construction of the taxonomy not only highlights the ‘cocktail’ nature of spirituality but also reinforces that the word is associated with a variety of meanings. The problem associated with the different meanings of particular words is not just specific to the area of ‘spirituality’. Cash (1990, p. 250) for example outlines potential problems with the use of abstract terms such as ‘nursing’, when discussing the concept of universals, by drawing on the notion of family resemblance. More
Universality
It has been suggested that current definitions of spirituality while, attempting to be all embracing, are not universal. If one strips away the descriptors, or layers of meaning then, implicit within many contemporary definitions, is the notion of a functioning intellect—the ability to reason, for a more detailed account of this debate see McSherry (2001). Close scrutiny of the definitions offered (Table 1) finds a number of descriptors used, Murray and Zentner (1989, p. 259) use the word ‘
Implications for practice and education
The ambiguity and misconceptions that still surround the meaning of spirituality may prevent the application of the concept within practice and education. If there is confusion around the literal and hidden meaning of the word, in that it means different things to individuals from diverse faiths then this will have implications for nurses in the course of their clinical practice. The taxonomy outlined suggests that there may be ‘diverse spiritual taxonomies’ all with the potential for conflict
Conclusion
In conclusion it would appear that there is no such thing as a universal definition of spirituality and the theoretical probability of creating one is virtually impossible. Historically the word derived meaning, connotational and denotational, from its association with religion and theistic beliefs—‘old’ form. However the legacy and emotive powers surrounding the word still remain. Presently there is a conscious move to fashion a definition of spirituality that is modern reflecting secular,
Acknowledgements
We would like to thank Professor Roger Watson, Dr Linda Ross and Joanna Smith for their constructive comments concerning the manuscript.
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