The language of spirituality: an emerging taxonomy

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Abstract

Background: This paper explores the relationships that exist between the language used to describe spirituality within nursing and the appropriateness of constructing a universal definition acceptable to all individuals. ‘Spirituality’ is a term that is increasingly used in nursing but there may be problems about exactly what the term means and how it is interpreted and understood by both nurses and patients.

Aim: The aim of the paper is to explore some of the commonly cited definitions to establish if the concept of spirituality could be termed ‘universal’.

Method: This paper presents a discussion, based upon a literature review, of the nursing and health care databases, combined with manual searches. The review demonstrates how the term spirituality is being constructed within nursing suggesting that there are numerous definitions each with several layers of meaning.

Findings: From the review the authors have developed ‘a spiritual taxonomy’ that may explain and accommodate the different layers of meaning found within nursing and health care definitions. At the extreme left there is a spirituality based on religious and theist ideals, while at the extreme right there is a spirituality based upon secular, humanistic, existential elements. A middle way is explained containing elements from both the left and right but not as fundamental or radical.

Conclusion: The authors argue that because there are so many definitions with different layers of meanings, spirituality can imply different things depending upon an individual's personal interpretation or worldview. The results of the review suggest nursing is constructing a ‘blanket’ definition of spirituality, which has a broad, almost inexhaustible set of defining characteristics. If this approach continues then there is a danger that the word may become so broad in meaning that it loses any real significance.

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.

References (60)

  • J. Buckle

    When holism is not complementary

    British Journal of Nursing

    (1994)
  • P. Burnard

    The spiritual needs of atheists and agnostics

    Professional Nurse

    (1988)
  • W. Carr

    Spirituality and religionchaplaincy in context

  • N. Cawley

    Towards defining spirituality. An exploration of the concept of spirituality

    International Journal of Palliative Nursing

    (1997)
  • M. Cobb

    The Dying Soul Spiritual Care at the End of Life

    (2001)
  • C. Dawson

    Progress and ReligionAn Historical Enquiry

    (1945)
  • V. Deary et al.

    Elisions in the field of caring

    Journal of Advanced Nursing

    (2002)
  • DOH, 2001. Your Guide to the National Health Service. Department of Health,...
  • P. Draper et al.

    A critical review of spirituality and spiritual assessment

    Journal of Advanced Nursing

    (2002)
  • J. Dyson et al.

    The meaning of spiritualitya literature review

    Journal of Advanced Nursing

    (1997)
  • T. Emdon

    Cry freedom

    Nursing Times

    (1997)
  • S. Gilliat-Ray

    Sociological perspectives on the pastoral care of minority faiths in hospital

  • B. Golberg

    Connectionan exploration of spirituality in nursing care

    Journal of Advanced Nursing

    (1998)
  • J. Hall

    The search inside

    Nursing Times

    (1997)
  • J. Harrison et al.

    Spirituality and Nursing Practice

    (1993)
  • A. Henley et al.

    Culture, Religion and Patient Care in a Multi-Ethnic Societya Handbook for Professionals

    (1999)
  • K. Holland et al.

    Cultural Awareness in Nursing and Health Care

    (2001)
  • J. MacQuarrie

    Paths in Spirituality

    (1972)
  • J. Macrae

    Nightingale's spiritual philosophy and its significance for modern nursing image

    Journal of Nursing Scholarship

    (1995)
  • J. Males et al.

    Spiritual needs of people with a mental handicap

    Nursing Standard

    (1990)
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