Connecting

Many definitions of spirituality indicate that connecting-intra-, inter-, and trans-personally are integral to spiritual well-being. Spiritual health is manifested when one experiences harmonious connection internally, with other persons and with nature, and with the cosmos and its Creator (Taylor, 2002; Goldberg, 1998). It is through our relationships with others that we can fully understand ourselves and nurture our spirituality (Burkhardt & Nagai-Jacobson, 2002).

Facilitating connection is enabled as the nurse approaches the patient non-judgmentally and honestly. As trust develops (interpersonal relationship), the nurse begins to assess the patient's relationship with God, a Higher Power, or nature (transpersonal relationship). As the patient explores these areas, values are identified and clarified (intrapersonal relationship) (Reed, 1992).

Case Study

For a patient such as Diane in the case study, careful, sensitive assessment is imperative. Interventions must be tailored to stage of illness and the desires of the client at the time of the intervention. Spiritual care interventions to facilitate connection include presence, active listening, journaling, prayer, and reading spiritual materials.

Ways to Connect:

On a more practical level, oncology nurse clients have described connectedness as a requisite to, and an important aspect of, nurse-provided spiritual care ( Taylor , 2003). A qualitative study of 28 cancer patients and family caregivers found that ways connectedness was desired included having the nurse:

• Show kindness and respect (e.g., a smile, being nice, addressing person respectfully)
• Listen and talk (even "simple conversations" as one informant put it)
• Praying (privately for or with the client)
• Be authentic or genuine
• Be physically present (e.g., "be there when I need it" or "just stay for a few minutes")
• Relate to clients with symmetry, as partners or fellow humans (e.g., "show a personal interest, [client] not be a number").

Oncology patients and their family caregivers want to feel connected with their nurse before this nurse offers spiritual care. That is, the nurse should convey warmth and genuine interest, have developed rapport, and shown respect for client spirituality before providing any overt spiritual care ( Taylor ).

Barriers to Connection:

Although nurses sometimes believe that the barriers to deeply connecting with clients are attributable to external environmental factors such as work load, the most significant barrier to connection is arguably an internal one: burnout or compassion fatigue. Burnout creates nurse "silencing responses" to client suffering which prevents connection (Baranowsky, 2002). Indicators of this silencing response include:

• Changing subjects during conversation with clients
• Avoiding topics that are uncomfortable for the nurse
• Providing pat answers
• Minimizing client distress (e.g., "It'll get better")
• Being sarcastic (i.e., mutedly angry) with clients
• Faking interest in listening
• Boredom with client interactions
• Fearing what client will say
• Fearing you will be unable to help.

Resources

Printed:

Baranowsky, A. B. (2002). The silencing response in clinical practice. In C. R. Figley (Ed.). Treating compassion fatigue . New York : Brunner-Routledge.

Burkhardt, M. A., & Nagai-Jacobson, M. G. (2002). Spirituality: Living our connectedness . Albany , NY : Delmar.

Goldberg, B. (1998). Connection: An exploration of spirituality in nursing care. Journal of Advanced Nursing, 27 , 836-842.

Reed, P. (1992). An emerging paradigm for the investigation of spirituality in nursing. Research in Nursing & Health, 15, 349-357.

Taylor, E. J. (2003). Nurses Caring for the Spirit: Patients with Cancer and Family Caregiver Expectations, Oncology Nursing Forum, 30 , 585-590.

Taylor, E. J. (2002). Spiritual care: Nursing theory, research, and practice . Upper Saddle River , NJ : Prentice Hall.

Walton, J. (1996). Spiritual relationships. Journal of Holistic Nursing, 14 , 3.

Web:

http://www.spiritualityhealth.com/newsh/items/blank/item_182.html

http://www.innerbonding.com/index.lasso?did=content&content.article=120

http://www.everystudent.com/features/gettingconnected.html

Halstead, M., & Taylor, E.J. (2005)