Several authors from a range of health care professions (Culliford 2002; Henery 2003; McSherry 2004; Wright 2001, 2002) and from diverse cultures (Rassool 2000; Shirahama and Inoue 2001) have explored and discussed the concept of spirituality. Other commentators have identified an inventory of elements that are perceived as aspects of the spiritual dimension – for example, spiritual needs, spiritual distress, spiritual well-being and a general analysis of the words spirit and spirituality. It would appear that all these terms are interrelated. An investigation into each approach reveals and ‘sheds light’ on different facets of this multidimensional and mysterious aspect of life.

The lived experience

One way of learning to understand what is meant by the term spirituality is by reflecting upon what the term means to ourselves.

Having undertaken Activity 2.1, you will now appreciate that spirituality is often something that we may not consciously think about and, when asked to describe spirituality, we may find it difficult to articulate either a definition or a description. In describing spirituality, you may have jotted down several points:

•some pertaining to religion such as a belief in a God or a Supreme Being

•more general terms surrounding life such as relationships, beliefs, values, ideologies

•or even issues surrounding death and belief in an after life.

This reflection leads on to Activity 2.2.

Having thought about the word spirituality and reflected upon the things we value, one starts to appreciate why spirituality is something that we may take for granted. We all have an awareness and sense of importance towards certain things in life (revealed in Activity 2.2) that are personal and unique. By reflecting upon these things, it becomes apparent that everyday rituals, practices and people provide us with much of life’s meaning, purpose and fulfilment. However, we may never attach any spiritual significance to them. By spending several moments thinking about the things in life that we value, one can soon produce a list of items – for example, health, family, friends, career, etc. – that are fundamental to our existence and being. An analysis of this list reveals that many of the things that we take for granted link in with the concept of spirituality in that these are aspects of life that generate much of life’s meaning, purpose and fulfilment. If we are deprived of any of these because of illness, loss or misfortune, life can soon lose meaning and we can find ourselves questioning our existence at a very deep level, searching for answers and solutions. These important issues will be explored and discussed in a little more depth in the later section, ‘The ordinary and mundane’.

Having reflected upon the word spirituality, several important themes begin to emerge. The word spirituality may be interpreted differently by individuals. There is a uniqueness and originality in the way that we perceive the concept. However, what does become evident is that there are certain elements of the subject that are universal and applicable to us all (McSherry and Cash 2004). Spirituality does not only apply to the religious person but to every individual irrespective of religious affiliation. Emerging from this universality is the need for sensitivity when discussing this very personal concept.

Several authors (Coyle 2002; Dickinson 1975; Shelly and Fish 1988; Stoll 1989; Tanyi 2002) have investigated the concept of spirituality by first exploring possible meanings associated with the word ‘spirit’. Everyday usage of the word is illustrated by the definition in The New Oxford Dictionary of English, which provides two descriptions of the word that may help to demystify its use within health care:

1.of, relating to, or affecting the human spirit or soul as opposed to material or physical things…

2.of, relating to, religion or religious belief.

(Pearsall 1998, p.1794)

The above definitions suggest that the ‘spirit’ of a person is an entity on its own. They also suggest that it is an animating life force present within all individuals. It is also described as a frame of mind or attitude towards life.

Definitions of spirituality

After exploring the word ‘spirit’, the next step is to try and define what is meant by the word ‘spirituality’. It was stated earlier that the concept of spirituality is gaining much attention within the health care literature. A study of some of these articles and texts soon reveals that some of the definitions presented are very descriptive, anecdotal and rhetorical, presenting the views and opinions of individuals, which cannot be generalized and applied to the general population (Bradshaw 1996; MacLaren 2004; McSherry 1996; Turner 1996; Wright 1997). However, these publications do contribute to our understanding of the concept in that they provide us with an insight into what people feel and think about spirituality.

Among the numerous descriptive definitions of spirituality that are to be found in the literature, there are several that have been developed and used in research studies to provide a framework for investigation. One such definition of spirituality, which has been quoted and referred to in many texts, is that presented by Murray and Zentner (1989, p.259). According to these authors, spirituality is:

If we read this definition several times and reflect upon its meaning and significance to health care, several important themes may begin to emerge:

•the uniqueness of each individual is paramount

•formal religious affiliation is not a prerequisite of spirituality

•an individual may become more spiritually aware during a time of need.

This definition highlights the complex and subjective nature of spirituality, reinforcing the notion of mystery and transcendence. It demonstrates how all aspects of life – physical, psychological and social – are interrelated and interconnected. From this definition it would appear that spirituality is concerned with an individual’s past, present and future, especially when facing illness or the prospect of death. Reed (1992, p.350) adopts a similar description of spirituality when she writes:

Reed’s definition suggests that spirituality is concerned with the individual and his or her relationship with others and the environment, also reaffirming the notion that spirituality involves an awareness of something greater or beyond oneself (the mystical nature inherent in every individual).

Earlier you were asked (Activity 2.2) to reflect upon the things in life that bring you value and meaning. The two definitions of spirituality presented in this chapter suggest that it embraces all aspects of life that bring value and meaning, since they imply that spirituality is concerned with everyday events and concerns such as relationships, health, career, etc. Academics may argue that this is an oversimplification of the concept. However, if spirituality is to be relevant to health care and applied in clinical practice, then spirituality must be defined in a manner that makes it both meaningful and relevant for patients and all working within health care. A noticeable omission in the literature (particularly nursing) is that many definitions of spirituality have been constructed and perpetuated without any real criticality or analysis of them in terms of relevance to individuals and practice. Taylor (2002) and McSherry and Cash (2004) present tables in chronological order to show how spirituality has been defined within nursing and health care.

During a workshop on spirituality, one of the co-facilitators, a chaplain, made a useful observation concerning the word ‘spirituality’. Incorporated in the middle of the word ‘spirituality’ is found the word ‘ritual’, a word well known by nurses (Walsh and Ford 1989) and all health care professionals. What has this point to do with spirituality? Ritual means a regulated or repeated action, and this can be applied to religious practices and ordinary aspects of life. Within the context of a religious ceremony prayers or actions are carried out according to historical customs and practices – for example, the marriage ceremony. An example from nursing may be the ritual of recording daily observations without really asking if they are necessary. It would appear that all individuals require ritual and routine because they provide structure and security. Therefore, if one applies these principles to spirituality, it would seem that the word is concerned with ordinary events and routines of daily living. The definition offered by Murray and Zentner supports the idea that spirituality is concerned with the ordinary and mundane ritualistic events of life. This may appear a contradiction since the use of the word ‘mundane’ implies an absence of the spiritual. However, if one reflects upon daily living, it is often the mundane rituals such as going to work, doing the washing or walking the dog that bring meaning and purpose to everyday life. As suggested earlier, these ordinary and often mundane tasks are usually taken for granted, and the fulfilment derived from them is not recognized until an event occurs that causes a break in normal practices.

This is illustrated in Case study 2.1. John’s situation highlights that it is the everyday tasks and rituals that give structure, meaning and purpose. Nurses will encounter numerous patients like John who are trying to find new meaning as their roles and lives change. It is important to recognize that spirituality is not just concerned with matters of theology and existential beliefs, but about the ordinary and the mundane.

One important point to consider when trying to establish a definition of spirituality is not to make the subject complex and produce a definition that may be authoritative. The way forward is to think of spirituality in terms of its relevance and importance to individuals in their everyday existence. All people irrespective of creed, culture, race or religion have a spirituality that is uniquely interpreted and determined by their everyday situation.

Spirituality does not only equal religion

In an article entitled ‘The inner light’, Allen (1991) suggests that nurses would be more scandalized to find a Bible in a patient’s property bag than a copy of the Karma Sutra. Allen is highlighting the misconceptions surrounding spirituality and religion. In the past, the word spirituality has been used synonymously with religion. Any mention of the word spirituality either implied that a patient required the services of the hospital chaplain or that a nurse who attended to such patients was in need of a psychiatric referral. If one adopts such a narrow definition of the word and applies it only to the religious and pious, then there is a danger that a large proportion of patients and indeed nurses may not have their spiritual needs addressed. For some individuals, patients, service users and health care professionals, the religious aspect and the belief in a God will be fundamental and central to their interpretation of spirituality. However, if this definition were applied to all individuals, it would be extremely inappropriate and possibly offensive. It appears that in today’s society these two words are in conflict or opposition – the spiritual/ religious versus the secular and materialistic. Yet this conflict only arises if one chooses to be judgemental in the interpretation of the word spirituality by adopting a narrow definition. Tolerance, understanding and flexibility have to be used and applied when defining spirituality. Only by being tolerant to each individual’s religious orientation or political and philosophical persuasion will a true understanding of spirituality be gained. If one adopts this approach, then these two words will not be viewed in opposition but as elements or threads that contribute and make up the larger tapestry of spirituality.

The word spirituality is perceived and used differently by all individuals. By adopting this individualist approach, the meaning of the word becomes mysterious and subjective in that the term may mean different things to individuals within differing contexts. One way in which individuals, and indeed societies, try to describe or define the word is by using analogy and symbolism. An example can be found in the way that religions use drawings to illustrate their God(s). Ancient peoples drew figures of animals that they worshipped because they provided food. This approach can be applied to spirituality because images or illustrations with which people are familiar assist in providing visual stimulation and insight, allowing the hidden meanings or interpretations of the word to be revealed.

MOUNTAIN RANGE

Life is depicted as a journey or pilgrimage. Sometimes the route and the scenes are beautiful and idyllic. Yet there are times when the mountains are steep and difficult to ascend, and no sooner does one conquer one peak than another appears on the horizon that is much higher and steeper. Life and spirituality is like this for most individuals. At one period in time a person may be experiencing hardship and conflict that may be manifested as illness, disease or bereavement (the steep slopes). Yet there are many occasions when a person experiences joy and happiness, life is running smoothly and calmly, and everything seems to fall into place with little effort (the scenic routes). This analogy suggests that life can be difficult and that at some point events may occur that confront, challenge and test us. It is during this journey that a person’s spirituality is shaped and developed. This raises the notion that spirituality can be developed. In fact several authors have suggested that spirituality changes and evolves across a lifespan (Carson 1989; Erikson 1963). Our spirituality is not completed overnight, nor is it something static; rather it is transient and always in a state of flux. It is the spirit’s ability to adjust and change to situations, either religious or secular, that will ultimately shape an individual’s spirituality.

A FOOTBALL