Spirituality is often equated with religiosity and then fundamentally neglected in medical care, as a result of the perceived need to limit potential sensitive and personal discussion, especially with regard to differences of opinion regarding beliefs and practices between all individuals involved. (Tanyi, 2006) Yet, religion and religious beliefs are only a very small part of spirituality and there are a number of nursing interventions that have little if nothing to do with religion and a great deal to do with holistic health and wellness. There is a recognized connection between spirituality and health, and nurse leaders have acknowledged the importance of the spiritual as well as the physical in providing optimal nursing care. Spirituality goes beyond religious or cultural boundaries. Spirituality is characterized by faith, a search for meaning and purpose in life, a sense of connection with others, and a transcendence of self, resulting in a sense of inner peace and well-being. A strong spiritual connection may improve one's sense of satisfaction with life or enable accommodation to disability. (Delgado, 2006)

Nurses are particularly fundamental in their role as direct care givers to aide in bridging the gap between patients and medical care with regard to spirituality and its importance during pinnacle periods of health and/or illness. It has been well documented that spirituality, inclusive of or secondary to religion and/or religious beliefs is a fundamental aspect of holistic standards of care. Patients are far more than the requisite disease, family/social role and ultimately a body, they are living thinking feeling and believing individuals within the community that seek and need spiritual support as much as they need physical support from professional and lay caregivers. To neglect spirituality would be to leave out a core aspect of the whole of a person and further challenge their wellness. (Pesut, 2006) Clarification of spirituality, and the development of modalities and plans to address it in a functional way within a care giving experience is an essential current trend and is in dire need. (Miner-Williams, 2006) (Lane, 2005) Clinical experiences in which individuals and families both express need and communicate frustration with regard to spiritual needs, that are not being met are common, (Taylor & Mamier, 2005) (McEwen, 2005)but holistic focus in both nursing and the broader medical community is changing this phenomena and offering research and standards for addressing spirituality as a crucial human aspect. (Buck, 2006) (Baldacchino, 2006) (Ross, 2006) (Wilfred, 2006) (Delgado, 2006) (Sawatzky & Pesut, 2005)

A recent clinical experience of my own demonstrates the fundamental need for realistic clinical standards and practices for guidance with regard to recognizing and honoring spirituality with patients and caregivers. Patient E.G. An early to moderately progressed Alzheimer's/dementia patient in the medical ward for treatment of a non-related foot laceration, demonstrated concern about family cohesion related to spirituality. As a nurse, I often experience demonstrative examples of the need for a nurse to support and even council on such issues as a result of the fact that the nurse has a unique relationship with patients as both a helpmate and an outside opinion on issues of concern. Dementia patients also expeience periods of lucidity which often force them to face broader issues that are fundamental to family coping. In other words they are demonstratively aware, at times that their conditions will likely deteriorate to a point where they must face dependency upon family and other caregivers. The patient described concern about her injury, which had occurred as a result of her feeling the need to cook for herself and her family. She dropped a sharp knife on her foot. The resulting injury seems to have reminded her family of her impending disease progression. Her spiritual concern was that her children (3) and their spouses, all have conflicting spiritual beliefs, to her own and to those of each other. E.G. is ultimately concerned that the strengths of these beliefs are not foundational enough to provide for their mental and social wellness if changes must be made in the family to support her in her decline. E.G. is a widow who has lived alone for the last four years, since the death of her husband. E.G. asked myself and another nurse to help her decide how to talk to her family about her own spiritual needs, without conflicting with their own. (Tanyi, 2006) (Taylor & Mamier, 2005) Neither myself as a student nurse or the other staff nurse really knew how to approach the subject with the patient and collectively concluded to refer the situation to the staff minister....

The minister, though ecumenical is also affiliated with the faith of the institution, as the hospital is a religious not-for profit institution. This referral bothered E.G. As she felt that her own minister would be more likely to understand her concerns. Most importantly the referral was inadequate as it did not deliver all possible nursing interventions associated with spirituality. The most common of which are; referral, prayer, active listening, facilitation and validation of clients' feelings and thoughts, conveying acceptance, and instilling hope.
Offering referral seems to be a standard of care at many institutions, but one that is not always effective, as a result of the fact that the minister or social worker on staff might be resisted by the patient and/or the family as an interloper, especially in the case where spiritual issues are in conflict. According to the research of family specialist nurse researchers insist that family spirituality assessments are needed to allow holistic care; "Spirituality's positive effect is pervasive in health care and in the lives of many families; therefore, there is a need to integrate spiritual assessment and interventions in total family care." (Tanyi, 2006) Spirituality is a source of great comfort and possible conflict within the community of any individuals and though most express the desire to respect the wishes of the individual in care they also often have need for communication regarding these foundational issues, as was expressed by E.G. In the present case. Had a spiritual assessment been conducted on this family the individual might have been offered a more effective intervention by myself and the staff nurse. Spiritual assessments include active listening and conducting even a minimal assessment would include facilitation and validation of client's feelings and thoughts as well as offering the client hope for resolution of spiritual conflict and regained health and wellness. We might have had the contact information for the individual's own spiritual leader and been able to contact him or her without delay when one on one nursing intervention was only minimally effective. We may also have been more likely, had we been more aware of the situation to allow ourselves to be a part of a conversation specifically about spiritual communication, for the individual, to help ally her concerns and express her wishes to her family. (Baldacchino, 2006) (Wilfred, 2006) (Miner-Williams, 2006) Either or both intervention may have better responded to the needs of the patient and therefore aided in a greater overall spiritual experience. Additionally, a greater understanding of the issue of spirituality, its definitions, details and possible talking points and nursing diagnosis interventions would have been and will prove to be of great aide in the future. (Baldacchino, 2006) (Delgado, 2006) (Buck, 2006) (Miner-Williams, 2006) (Wilfred, 2006) (Taylor & Mamier, 2005)

The fact that spirituality is a crucial aspect of self, community and family is evident in the role of the nurse as a spiritual interventionist, as core principles of nursing and holistic care as well as competency expectations are present, yet the definitions and dialogues are often missing in the transition from holistic care theory and expectation to rational information about clinical possibilities and functions in the care community. Nursing education would clearly benefit from greater spiritual communication training and better communication of intervention standards. A current review of literature associated with spirituality in nursing demonstrates that the issue has come a long way over the years and can fundamentally be improved with not only awareness but demonstrated proofs of the effectiveness of spiritual care on the part of the nurse and others in the care community. (Ross, 2006) Gone are the days when simply providing a referral is adequate as the nurse holds a particularly crucial role as an intimate confidant in the care setting, with issues that have as much to do with emotional as physical health. (McEwen, 2005) A point that is very well made b Taylor and Mamier is that nurses are increasingly expected to respond to the spiritual needs of patients and that doing so will aide the family and the patient in fundamental ways. The work demonstrates that families often need and expect such intervention and that nurses must be not only sensitive and intimate but not overtly religious in their intervention. In the work caregivers and patients were questioned and the result was a general consensus that the kind of intervention that they might seek would be; "therapeutics that were less intimate, commonly used, and not overtly religious were most welcomed." (Taylor & Mamier, 2005)…