Transcript Martha Rogers and the Science of Unitary Human Beings

SPIRITUAL INTERVENTION AND THE
SCIENCE OF UNITARY HUMAN BEINGS
Australian College of Holistic Nurses
5th INTERNATIONAL CONFERENCE 2002
Touching the Spirit:
Ancient Wisdom in the Art and Science of Future Nursing
Hahndorf, SA Australia
Thomas Cox RN, MS, MSW, MS (Nursing)
Doctoral Candidate
Virginia Commonwealth University
School of Nursing
November, 2002
Objectives
• Describe the context for spiritual interventions from
a Rogerian paradigm
• Review literature on spirituality relevant to spiritual
interventions
• Describe two successful interventions delivered with
minimal organizational backing
• Suggest paths to spiritual intervention in practice
Premises
Opportunities for spiritual interventions arise naturally when
we attend to the integrality of the human-environment
fields, can be provided with minimal cost, time, and help if
the caregiver is attentive, responsive and creative.
Barriers to spiritual expression impair the ability of clients to
address their own spirituality - whether the clients and staff
perceive them as internal or external to the client, or do not
see them at all.
Removing obstacles to spiritual expression are likely to be
more effective than efforts to compensate for such obstacles,
allowing people to engage naturally in spiritually
meaningful activities is easier than mobilizing resources
Science of Unitary Human Beings
Humans are energy fields - integral with and in
continuous mutual process with environmental
energy fields
• Though Rogers does not specifically address
spirituality, integrality is similar to other spiritual
conceptions such as oneness, prime mover, Freud’s
‘oceanic feeling’, flow, presence, nature, being
• Malinski - integrality is what is experienced when
people have spiritual experiences.
• SUHB nurses often center and meditate before
nursing activities, as do other nurses
Dimensions of Spirituality
Meaning-making
Meaning, purpose, or significance of human life
Values clarification
beliefs and standards about what we hold to be true,
beautiful, sacred, profane
Transcendental or integral relationship to the infinite
experience and appreciation of pandimensionality; oceanic
feeling, synchronicity, archetypes, unboundedness
Connecting with self and others
including relationship with God(dess), higher power, Gaia
Unfolding/Becoming
Beliefs regarding an evolutionary course to life, that we
evolve consciously, and to a higher state of being
Defining Characteristics of Spiritual Distress
• Necessary: Experiencing a disturbance one’s belief
system.
• Possible:
– Questioning of one’s own belief system.
– Experiences discouragement, despair, spiritual
emptiness
– Unable to practice usual religious rituals.
– Has ambivalent feelings (doubts) about beliefs.
– Believe (s)he has no reason to live.
– Emotionally detached from oneself and significant
others.
– Is concerned, angry, resentful, afraid – regarding life,
anguish, death.
S1
• Impaired Coping
• Humor
• to facilitate appreciation of that which is funny, to relieve
tensions
• Hopelessness
• Hope instillation
• to promote a positive sense of the future
• Spiritual Distress
• Spiritual support
• to facilitate a sense of inner peace
• Spiritual Well-Being
• Spiritual growth facilitation
Institutional Support for Spiritual Work
• Joint Commission for Accreditation of Healthcare
Organizations (JCAHO)
– Address the spiritual needs of diverse clients
• World Health Organization
– The definition of health includes four domains of wellbeing: physical, mental, social and spiritual.
• The North American Nursing Diagnosis Association
– spiritual distress is a nursing diagnosis
• International Council of Nurses Code for Nurses
– Requires that nurses address patients’ spiritual needs
• Nursing Interventions Classification System
– "hope instillation", "spiritual growth facilitation" and
"spiritual support" are appropriate nursing interventions
Examples of Spiritual Interventions
Issue/Diagnosis
Action
Justification
Help clients
achieve a
Hopelessness
Instill Hope
positive view
toward the
future
Help clients
achieve a sense
Spiritual
of inner peace
Spiritual Distress
support
regardless of the
situation they
face
Support clients
Assist
efforts to grow,
Spiritual Wellclients with reflect on and reBeing
spiritual
examine values,
growth
decisions, and
actions
Impediments to Spiritual Intervention
• Lack of specific resources
• Differing definitions of spirituality and religion
• Uncertainty of the appropriateness of spiritual
intervention
• Lack of peer support and limited continuity for
spiritual interventions
• Inadequate resources for specific spiritual
interventions.
The Clients
• J - A short term, though considered to be a
potentially long-term referral for chronic care,
voluntary, acute admission to a university affiliated
in-patient, mental health facility
• S – a long-term (15+ years) patient at a state run
psychiatric hospital on a ward for aggressive male
clients
J1
• Young, White/American-Indian male, severe
depression, suicidal ideation – deemed long-term.
• Had not spoken since admission and refused
medications
• Approached casually, sat side by side for 20
minutes, and eventually asked how he felt about
being ‘here’.
• He stated distaste for being unable to be ‘outside’.
J2
• Upon further gentle probing around Native
American issues – explains that he spent most of his
time hunting, fishing and scavenging on family land.
• Intervention - pharmaceuticals are a method of
healing, blended by powerful, shamanic figures,
based on natural healing remedies found in nature
• J accepts meds, works on several healing issues, and
leaves in a matter of days.
S1
• Older, African-American male.
• Hospitalized in a public psychiatric hospital for 20+
years.
• Refuses to sleep in a bed
• Frequently heard mumbling: “Come to Jesus”
• Behavioral intervention team tries traditional
behavior modification approach with edible reinforcers.
S2
• S eats treats and refuses to stay in room
• Intervention – secure a tape player from behavioral
team and play Gospel music in client’s room.
• Client eats snack, listens to music, unfolds unused
bed, climbs in and sleeps for several hours – first use
of a bed in 8 years
• Over several days, when nursing staff took the time
to set the environment in his new room up, and sit
with him for a few minutes, S would quietly eat his
snacks and spend some time sleeping in his room
Recommendations 1
• Spiritual interventions are as much a matter of
recognizing the need as of developing the
intervention.
• Often, all that is needed is permissions frequently
denied in the setting, to be themselves.
• Resources for spiritual interventions are low cost,
flexible, and need not present conflicts for staff.
• Attend to the expressed needs, the impediments to
immediate gratification, and use a little creativity.
Recommendations 2
J’s behavior and ideation could have been interpreted
as delusional or a symptom of substance abuse
rather than spirituality – accepting his frame of
reference for his behavior as spiritual was a key to
working with him.
Recommendations 2
S was a frequently violent and nearly impossible to
understand when agitated. Nobody ever thought
about why he was singing or how it might be used to
help him.
In fact, it was conventional wisdom on the unit that
when S started singing he was soon likely to get
violent.
In fact, an entire team of psychologists, nurses,
behavior therapists, and social workers designed a
behavioral intervention that was nowhere near as
effective as a cassette tape with hyms.
S1
• Older,
S1
• Older,