Abstract: Nursing’s most influential theorists of the decades from the 1950s through the 1980s paved the way for the profession’s almost universal acceptance of a postmodern worldview that radically alters nursing’s understandings of personhood, healing, and health care. No longer is the physician the healer, nor the nurse his handmaiden. Instead, the healer is the Self—the Divine within. Alternative therapies assist patients in accomplishing their own healing. The purpose and goal of the nurse is to provide physical, psychosocial, and spiritual care to empower patients to recover health through a variety of self-healing techniques involving direction and exchange of spiritual forces or energies. Nursing theory and practice reflect a postmodern worldview that contrasts with both the skepticism of modernism’s scientific rationalism and orthodox Christianity’s biblically based understandings of divine and human personhood, health nad healing.
You can heal yourself! A popular theme in health care today that is surfacing everywhere, it promises wondrous results, encouraging and empowering people to take responsibility for their own health. For example, a brief article in Better Homes and Gardens magazine’s “Health Update” column urges readers to “chant away high blood pressure” by combining meditation with medication. Reporting results of a study in the American Heart Associations’ journal Hypertension, the column claims that “Transcendental Meditation (TM) effectively reduced high blood pressure in a group of African-American men and women with high stress and other high risk factors of the disease.” TM is described as a “technique” that involves “sitting in a comfortable position and repeating a sound or word for 20 minutes, usually twice a day. The goal is to eliminate all distracting thoughts and gain a deep sense of restful alertness.”1 Postmodern nursing has embraced Transcendental Meditation along with a number of other “techniques.” Amid the tubes and lines and high-tech medical devices in intensive care units (ICUs) across the country, a quiet revolution is spreading, accompanied by the soothing sounds of music synthesizers and the gentle touch of nurses trained in contemporary versions of the ancient art of laying on of hands. Complementary therapies range from acupuncture, acupressure, aromatherapy, and massage to therapeutic touch, healing touch, music therapy, and guided imagery—all are subsets of holistic medicine which emphasizes a mind/body/spirit approach to health.2
In claiming that holistic care has gained acceptance in hospitals around the country, Medical Ethics Advisor notes that nursing organizations tend to be less guarded (than physicians) in their acceptance of “alternative,” “adjunctive,” or “complementary” therapies3. Nurses and patients alike are attracted to these approaches for many reasons:
Consumers are dissatisfied with impersonal, expensive interventions that treat the body as a mechanical object and do not care for the whole person. Nurses are disillusioned with the health care system, including its lack of concern for the whole person and the relative impotence of nurses within the system. . . . Alternative therapies offer something “new” when nothing “traditional” seems to help ease pain, provide hope and engender a sense of human connectedness, wellbeing, transformation. . . . [They] also appeal to a growing desire for power among nurses . . . to diagnose, prescribe and treat without a physician’s order, intervention or supervision. [They] edge nurses into medicine, albeit “alternative” medicine.4
Part of the wide appeal of alternative therapies for nurses and patients alike is their apparent simplicity and benignity. Many appear noninvasive, easy to do and teach, fairly inexpensive, and seemingly risk free. In a medical environmental highlighted by catastrophic care, life-support systems, prolongation of dying, and the perceived medical preservation of bodily functions without any accompanying quality of life, “safe healing” has become a desirable commodity.
A CLASH OF WORLDVIEWS
What is not as readily apparent to many nurses and patients is the philosophical perspective (or worldview) and the primary values underlying the self-healing movement and key alternative therapies, including yoga, acupuncture, therapeutic touch, guided imagery, and various form of meditation or centering. Nurses and their patients are often completely unaware that the worldview inherent in many alternative therapies favored by the self-healing movement is distinct from and ultimately incompatible with each of two other worldviews that have shaped the history and values of the nursing profession. And because most nurses are not aware of important differences, they are not able to clarify them with patients when discussing alternative therapies or in seeking patients’ informed consent for their use.
In fact, most nurses and patients are not aware that they even have a worldview or that it is something distinct from (but often related to) their religious beliefs— or that other worldviews, quite different from their own, exist. A nurse may not be aware that his or her worldview could be very different from that of a patient. And these differences, whether overt or covert, can produce conflict.
Few people have anything approaching an articulate philosophy . . . and even fewer have a carefully constructed theology. But everyone has a worldview. Whenever any of us thinks about anything—from a casual thought (Where did I leave my watch?) to a profound question (Who am I?)—we are operating within such a framework. In fact, it is only the assumption of a worldview—however basic or simple—that allows us to think at all. A worldview is a set of propositions (or assumptions) which we hold (consciously or subconsciously) about the basic makeup of our world. The first assumption . . . is that something exists. What we discover quickly, however, is that once we have recognized that something is there, we have not necessarily what that something is. And it is here where worldviews begin to diverge.5
In the latter half of the twentieth century, nursing has experienced a significant worldview shift away from both the religious worldview of theism and the worldview of modern science (naturalism or materialism). These two worldviews, theism and naturalism, together shaped the foundations of nursing in the twentieth century, since they were compatible on many points (although on some they are incompatible). Nursing has, however, through the efforts of some leading theorists, begun to adopt various adaptations of the prevailing postmodern worldview—a pantheistic monism. Pantheistic monism is not new. But the term “postmodernism” is recent, and is misleading as it suggests a more modern—a “new and improved”—worldview.
Athough all three of these worldviews may use some of the same terms (“God,” “spirit,” “divine,” “energy,” “matter,” “person,” “holistic,” etc.) in describing their various understandings of ultimate reality, the meanings of these terms vary greatly from worldview to worldview. When words that seem to be synonymous— e.g., “prayer,” “mediation,” “centering”—are used in the care of patients, the words may have different, even contradictory meanings, depending upon the worldview context in which they are used. A nurse describing the process of guided imagery must take care to avoid conveying the impression that meditation or centering is the same as the biblical practice of prayer. Patients have the right to be informed not only of any risks and benefits of “alternative” therapies but they also have the right to know that some “alternative” therapies are actually alternative religious practices that could conflict with patients’ religious beliefs.
All worldviews attempt to explain the most fundamental nature of reality, but do so quite differently. A well-rounded worldview includes basic answers to each of the following questions.
- What is prime reality—the really real? To this, we might answer God, or the gods, or the material cosmos.
- Who is man? To this we might answer a highly complicated electrochemical machine whose complexity we do not understand, or a personal being created by God in his own image, or a sleeping god, and so forth.
- What happens at death? Here we might reply that human beings experience personal extinction, a transformation to a higher state, or departure to a shadowy existence on the “other side.”
- What is the basis of morality? We might say, among other things, the character of God, the affirmation of human beings, or the impetus toward cultural or physical survival
- What is the meaning of human history? To this we might answer to realize the purposes of the gods, to make a paradise on earth, to prepare a people for life in community with a loving and holy God, and so forth.6
Nursing theorists have played a crucial role in introducing into nursing practice the postmodern worldview of pantheistic monism and the self-healing movement with its variety of therapies. In order to understand the worldview shift initiated by these theorists, it is essential to contrast pantheistic monism with the two other worldviews that have also influenced nursing practice: theism and naturalism. The “theology” of these worldviews must also be examined, because nursing has always been concerned about patients’ spiritual needs. Much of postmodernism’s attractiveness to nursing lies in its spiritual claims. Hence understanding nursing’s traditional views on spirituality (predominantly Christian theism in Western countries) is important in appreciating nursing’s openness to postmodern ideology.
Naturalism, like pantheism, is a monistic worldview. Monistic worldviews agree on the premise that ultimate reality is one unified substrate: “all is one,” all apparent distinctions or differences in what we see and experience can ultimately be reduced to one, single, whole underlying reality or being. This reality is impersonal. Naturalism and pantheism disagree on what this one, unified ultimate reality is: matter/physical energy or spirit/psychic energy.
Pantheism states that all that is is ultimately non-material: ultimate reality is spirit (spiritual energy) or God (sometimes spoken of as Divine Mind, but always impersonal despite the capital letters). Those familiar with the Star Wars movies might think of this ultimate reality as the Force, recalling that the Force is “it,” not “he” or “she.” Pantheism is the worldview underlying many major Eastern world religions such as Hinduism, Buddhism, and Taoism, and offshoots like yoga, the marital arts, Transcendental Meditation, acupuncture, and Ayurvedic medicine. It is the worldview behind such Western belief systems as Christian Science (a religion despite the use of the term science), Theosophy, and the New Age movement.
Naturalism also requires ultimate reality to be one substrate, but that is matter or physical energy. Naturalism denies the existence of nonmaterial realities or forces such as “spirit,” “soul,” “mind,” “intent,” “will,” or “freedom.” Naturalism is the worldview behind the progress of Western science.
Theism is not a monistic worldview. It is often called a dualism, although that term has confusing meanings. Theism believers state that a personal God is the Ultimate Reality but that a reality distinct from God—the created universe—also exists and is dependent on God for its existence. The created universe is not identical with God. God is spirit, but the created world is both matter and spirit. Theism includes both matter and spirit as real and does not deny the ultimate reality of one in affirming the reality of the other. Theism is the worldview underlying religions like Judaism, Christianity, and Islam.
Deism, an early form of scientific naturalism, attempted to harmonize some aspects of theism with naturalism but found it difficult to remain strictly monistic. Many such attempts at unifying worldviews exist (e.g., Christian Science and the New Age movement attempt to harmonize pantheism and naturalism or pantheism and theism) but are ultimately unsuccessful because of inherent and unresolvable contradictions. Syncretism is the attempt to combine worldviews by denying their real, fundamental differences and attempting to reduce these to “underlying agreement” or “universal truth.” It may redefine key terms to produce a harmonization of worldviews. Syncretism is a perspective of existence which itself is most consistent with monistic (“all is one”) worldviews in which duality, otherness, contradiction, difference, and particularity ultimately cannot exist.
POSTMODERNISM’S INFLUENCE ON THE PROFESSION OF NURSING
Postmodernism is a convenient label to categorize a movement of ideas, beliefs, and cultural values that rejects many assumptions of modernism—naturalism in the form of Enlightenment scientific rationalism. Modernism proclaimed the emergence of discoverable reality through scientific inquiry and rational thinking in a universe devoid of any supernatural dimensions or ultimate purposes.
Most of us in the West have grown up under the sway of modernism, a school of thought that stretches back to the period in European history known as the Enlightenment. By the early 1700s, advances in science . . . had persuaded intellectuals to reject the medieval view of nature. When scientific observation directly contradicted church pronouncements, people discarded the church’s dogma. People became modern. They were “enlightened” . . . these modernists viewed nature as a grand machine whose processes could be understood by . . . natural law. People began to study nature by applying reason . . . more and more scientists came to view God as an unnecessary theory . . . the modernist worldview assumes naturalism . . . [and] directly challenges the Christian view. . . .7
Postmodernism represents a movement away from modernism’s dependence on rationalism and naturalism. Postmodernism substitutes relativism for rationalism and pantheism for naturalism but ultimately remains monistic and syncretistic.
Relativism says that truth isn’t fixed by outside reality, but is decided by a group or individual for themselves. Truth isn’t discovered but manufactured. Truth is ever-changing not only in insignificant matters of taste and fashion but in crucial matters of spirituality, morality and reality itself . . . this is the postmodern consensus . . . we in the West have been taught that truth cannot be self-contradictory. But in Asian religions and culture, truth can often be contradictory . . . we are left with “local knowledges” or “paradigms.” Within each paradigm people think differently and have their own truth which is real to them. . . . Postmodernists use language that implies the existence of the personal self, but their outlook points to the disintegration of self. The notion distinct personhood, according to postmodernists, is an illusion.8
A hallmark of postmodernism’s impact on nursing is the preeminence of holistic therapies and self-healing techniques. These claim to be wellness-centered rather than disease-centered. The concept of “healing” is based on creating one’s own reality—a reality of well-being— through being attuned to or “at one”—the Judaeo-Christian term “atonement”is sometimes reinterpreted to mean “at-one-ment.” “Healing” occurs with supernatural energy, energy that is not visible or measurable by scientific processes and not manageable or predictable according to laws of cause and effect. A nurse’s task, then, is to assist or empower patients to create their own healing by adjusting healing energy in the body/psyche/ spirit through a variety of interventions such as therapeutic touch’s “unruffling” (passing the hands several inches above the body), centering, imaging, yoga, etc. Nurses and patients are taught that a central part of this empowering, self-healing process is the realization of one’s essential unity with all things—one’s own inherent divinity.
A 1996 Time magazine feature article examined self-healing, asking “can prayer, faith, and spirituality really improve health?” Faith, as discussed in the article, was understood not to be specific to any religion or denomination. The faith of postmodernism is generic. Faith is believing, not beliefs—process, not content. Postmodern faith is an active, holistic process engaging body, mind, and spirit but seemingly free from adherence to any particular religious content, specific beliefs, or doctrines. Creeds and dogmas such as one would find in the Christian tradition tend to be viewed as fundamentalistic, narrow-minded, and rigid or are simply redefined through syncretism into the postmodern pantheistic context. Prayer, for example, is understood by postmodernism to be the equivalent of meditation or the “relaxation response,” involving the process of centering or creating an internal focus on one’s inner self through the repetition of words or mantras to produce an “altered” state of consciousness. Specific religious content is seen, in fact, as an impediment to the faith process, which should be doing, not thinking.
What attracted me to meditation was its apparent religious neutrality. You don’t have to believe in anything: all you have to do is do it. The God I have found is common to Moses and Muhammad, to Buddha and Jesus. It is known to every mystic tradition . . . it is Spirit, Being, the All.9
Faith (meditation/centering/prayer) is understood to be a spiritual, not religious, tool or technique involving a monologue with the inner self rather than a dialogue with God, a person distinct from the individual. Where there is dogma conflict, syncretism enables the postmodern believer to assert that the impersonal Self/One/All/Divine/Mind/Spirit is simply another name for the personal God. For Christians, for example, Jesus is interpreted through pantheism to be a “manifestation of the Christ” in the same sense that all souls are said to be the Christ—the Divine within. For the Christian theist, to define faith or its objects in this way would be considered misleading, even heretical.
Postmodern nursing practice has accepted the generic, universal faith of pantheism:
. . . religion refers to a belief system—a product of the rational mind . . . attentiveness to spirituality goes beyond a focus on religiosity. Spiritual care needs to be based on a more universal concept . . . rather than focusing around religious concepts.10
Postmodern nursing relegates religions to be products of human thought, composed of particular ideologies and rejecting competing ideologies. The preferred term, spirituality, enables the postmodern nurse to escape the need to deal with the truth or falsity of any one set of exclusive faith claims as exist in Christianity and Judaism. By defining faith as a neutral, generic, content-free process, nursing is able to introduce patients to certain practices and beliefs (such as those connected with Transcendental Meditation and therapeutic touch) as alternative therapies rather than alternative religions.
In the last 30 years, both American society and American nurses have changed what they believe and value, and these changes have helped reshape the ways that nursing professionals define religion and spirituality. Religious words like God are frequently replaced with more broadly defined words such as transcendence. Since nursing care grew out of religious teachings that emphasized care for the sick, that care was closely intertwined with religious practices . . . the hospital is the product of centuries of Christian belief and practices. But as America became secularized in the 1960’s and 1970’s, the religious emphasis declined . . . and Eastern holistic views added a concern for spirit as an essential component of nursing11
POSTMODERNIST THEORIES SHAPE NURSING PRACTICE AND PATIENT CARE
Worldviews and the theories that emerge from them shape the consciousness and moral behaviors of their adherents. Although fragmentary attempts at theoretical nursing were evident in the work of Florence Nightingale in the nineteenth and early twentieth centuries, the development of complex theories began around 1955.
Nursing theorists’ conceptual models are important means for advancing and potentially improving nursing practice by guiding the professional development of individual nurses, shaping values, and structuring nursing’s contributions to society. But it was nursing theorists’ attempts to develop a comprehensive understanding of human nature that made the profession of nursing most receptive to the self-healing therapies of postmodern pantheism. These also paved the way for nursing’s rejection of the secularism and skepticism of modernism in favor of a focus on spirituality in nursing and an approach to spiritual care of patients that appears doctrinally neutral but in reality is the antithesis of its theistic foundations.
Nursing theories provide a holistic or comprehensive perspective of human beings under varying life situations or environmental conditions and prevent nursing from viewing human beings simply as organs, body systems, or in other partial fragmented ways.12
As nurses began reflecting on the conceptual aspects of nursing practice . . . they turned to the philosophical inquiry . . . to understand the philosophical premises underlying nursing theory and research. The emerging theories addressed the nature of the human being. . . .13
In the late 1960s the American Nurses Association (ANA) initiated the development of standards of practice (published in 1973, revised in 1991), in which nursing diagnosis is identified as an essential dimension of nursing practice. Prior to this, diagnosis was defined by law to be within the province of medicine and outside the scope of nursing practice. The North American Nursing Diagnosis Association (NANDA) defined nursing diagnosis to be distinct from the medical diagnosis of disease. Nursing diagnosis is “a clinical judgment about individual, family or community responses to actual or potential health problems and life processes.”14
When nurses make a nursing diagnoses for a patient, they plan, carry out, and evaluate nursing interventions based on the diagnosis. Nursing diagnosis is thus understood to be essential to all of nursing practice. Nursing diagnoses are based on nursing theories which include beliefs about the nature of human beings and health.
Despite the fact that nurses are not routinely trained as chaplains or counselors, they diagnose and treat their patients’ “spiritual distress.” NANDA defines spiritual distress as a condition requiring such interventions as values clarification, relaxation training, and centering prayer. Nurses are to “encourage patients to take responsibility for their own life” and help them affirm that “God loves and accepts you as you are.”15 These nursing interventions are consistent with what has perhaps become the bumper sticker slogan of postmodernism: “Believe in yourself.” But for patients with other worldviews, theistic or agnostic, these are misleading statements or perhaps even offensive.
NANDA recommends therapeutic touch as the preferred intervention for another nursing diagnosis, “energy field disturbance, . . . the state in which a disruption of the flow of energy surrounding a person’s being results in a disharmony of body, mind and/or spirit.”16
This is different from the alternative therapy of Therapeutic Touch (TT) introduced by nursing professor Dolores Krieger in the 1970s. Krieger developed her theory of TT in relation to a worldview of pantheistic monism expressed in Theosophy, a nineteenth-century combination of Eastern religion and occultism, in which the healer is the self—nurse/patient. Although practitioners claim the therapy is nonreligious, elements of Buddhism, Hinduism, Taoism, Native American spirituality, Wicca (witchcraft), occultism, and goddess religions are often advocated. Healing Touch (a form of TT), for example, was developed, according to its founder, from techniques channeled to her by spirit guides.17
Nursing’s acceptance of self-healing and the practices of alternative therapies began as nursing theorists struggled to define health and illness, clarify the scope of nursing practice and the role of the nurse, and appreciate the concerns of patients in a health-care system that was beginning to be rocked by changes—the development of complex technologies (e.g., dialysis, ventilators, organ transplants, intensive care units), pressures from consumer-rights and patient-advocacy movements, skyrocketing health-care costs and complex reimbursement systems, and the emergence of an increased independence in nursing practice (e.g., home health, midwifery).
One of the first nursing theorists to suggest a postmodern understanding of self-healing was Ernestine Wiedenbach, whose redefinition of the nature of the patient has been significant in shaping the nursing profession. She developed a perspective of human nature that highlights a postmodern secular “faith” of self-reliance and suggests the relativism of moral values.
Each human being is endowed with the unique potential to develop—within himself—resources that enable him to maintain and sustain himself. The human being basically strives towards self-direction and relative independence and desires . . . to make the best use of his capabilities and potentials. . . . Self-awareness and self-acceptance are essential to the individual’s sense of integrity and selfworth. Whatever the individual does represents his best judgment at the moment of his doing.18
Lydia Hall, another early theorist, developed concepts of personhood, self-awareness, and self-healing derived, in part, from Carl Rogers’s psychology of client-centered therapy, which encourages individuals to become self-directed.
Illness is directed by one’s feelings of out-of-awareness. . . . Healing may be hastened by helping people move in the direction of self-awareness. Once people are brought to grips with their true feelings and motivations, they become free to release heir own powers of healing.19
Nursing theorist Jean Watson has developed a theory of nursing as caring. Influenced by the works of postmodern philosophers and psychologists including Rogers, Maslow, Erikson, and Heidegger, Watson believes professional nursing culminates in a human care project between nurse and client that transcends time and space and has spiritual dimensions.
The goal of nursing is to facilitate the individual’s gaining a higher degree of harmony within the mind, body, and soul which generates self-knowledge, self-reverence, self-healing. . . .20
For Watson, health and health care are holistic, involving transpersonal, metaphysical dimensions.
Health refers to unity and harmony within the mind, body and soul. Health is also associated with the degree of congruence between the self as perceived and the self as experienced.21
Watson states that what has been traditionally called health care is a myth: That which has been called health care, the diagnosing of disease, treatment of illness, and prescription of drugs, is medical care. True health care focuses on life style, social conditions and environment. . . . Illness may not be a disease . . . but may be a disharmony between body, soul and spirit. . . . Watson believes the individual should define his or her own state of health or illness since she prefers to view health as a subjective state within the mind of the person. . . . Nursing’s goal . . . is to help people . . . gain insight into the meaning of happenings in life.22
Watson’s understanding of health and healing is both postmodern in its relativism and pantheistic in its subjectivity. The mind/self/spirit creates its own reality without reference to any external or absolute realities or truths. Watson clarifies these differences in greater detail in a chart contrasting “traditional” and “emerging alternative” contexts (see p. 45).23
Traditional Medical Natural Science Context
Emerging Alternative Nursing Human Science and Context for Caring
|Absolutes, givens, laws||Relativism, probabilism|
|Human as object||Human as subject|
|Objective experiences||Subjective—intersubjective experiences|
|Concrete—observable||Abstract—may or may not “be seen”|
|Human = sum of parts (bio-psycho-socio-cultural-spiritual-being)||Human = mind-body-spirit gestalt of whole being (not only more than sum of parts, but different)|
|“Real” is that which is measurable, observable, and knowable||“Real” is abstract, largely subjectively as well as objective, but may or may not be ever fully known, observable, fully measured, what is “real” holds mystery and unknowns to be discovered|
Nursing theorist Betty Neuman defines health as “living energy” and understands that nursing has as its goal those acts that conserve energy. However it is the nursing theory of Martha Rogers that perhaps most fully develops pantheistic themes. Rogers understands reality to be a unified whole in which human beings are constantly exchanging energy with their environment.
. . . the four building blocks identified by Rogers [are] energy fields, openness, pattern and four-dimensionality. A unifying concept for both animate and inanimate environments, energy fields have no boundaries; they are invisible and extend to infinity, they are dynamic. Thus, these fields are open, allowing exchange with other fields. The interchange between and among energy fields has pattern that is perceived as a single wave; these patterns are not fixed but change as situations require . . . unitary humans are defined as irreducible four-dimensional, negentropic energy fields. . . . The science of nursing is directed toward describing the life process of humanity and toward explaining and predicting the nature and direction of its development . . . the nurse helps the individual move forward to a higher, more complex level of existence.25
The energy-based pantheistic theories of Rogers and Watson most fully set the stage for nursing’s acceptance of a postmodern, syncretistic worldview that denies absolute truth and reduces genuine doctrinal differences among religions to a generic spirituality for all patients.
The editors of the New Age Journal report [that] all of the healing systems that can be called “holistic” share a common belief in the universe as a unified field of energy that produces all form and substance. . . . This vital force, which supports and sustains life, has been given many names. The Chinese call it “chi’i,” the Hindus call it “prana,” the Hebrews call it “ruach,” and the American Indians name it “the Great Spirit.” This energy is not visible, measurable, scientifically explainable energy, but a “cosmic” or “universal” energy based on a monistic (all is one) and pantheistic (all is God) worldview. To enhance the flow of “healing energy” in the body . . . one must “tune” to it and realize one’s unity with all things.26
Critique of Self-Healing Theories and Practices
Many nurses are attracted to postmodern theories and therapies of self-healing because of their strong emphasis on spiritual care, an emphasis that is often lacking in traditional health care. This spiritual focus is attractive because it is believed to provide benefits to both nurses and their patients without creating risks. Perceived benefits often include
- a strong feeling of acceptance, closeness, bonding, and rapport between nurse and patient that deepens trust and helps patients cope with doubt and fears;
- an increased feeling of self-confidence or a reclaiming of power in the face of a serious perhaps life-threatening condition and within a traditional health-care setting that often leaves both patients and nurses feeling helpless, powerless, and out of control;
- the sense that deeper spiritual needs—including needs for love, belonging, hope, forgiveness, and on an unconscious patient. Many nurses who practice therapeutic touch have told me they do not cede to the exclusive demands of a particular religious dogma, denomination, or ritual;
- a sense of appreciation of the mystery, the mystical, and the sacred in forms that are perceived to be more vibrant or alive than the dry, listless routines of one’s childhood, culture, or past experience; and
- the promise of infinity or immortality in self-trancendance:
- A person’s body is confined in time and space, but the mind and soul are not confined to the physical universe. One’s higher sense of mind and consciousness transcends time and space and helps to account for notions like collective unconsciousness, a causal past, mystical experiences, parapsychological phenomena, a higher sense of power, and may be an indicator of the spiritual evolution of human beings.27
But risks do exist; and because nurses are required by their professional codes of ethics to be advocates for their patients, they must be aware of these risks and advise their patients of them:
- With its message of healing that promotes well-being through self-effort, this spirituality of self-worship appeals to a narcissistic culture that is affluent, successful, young, and healthy; it is not as appealing to those who are marginalized, disadvantaged, chronically ill, or physically or mentally challenged.
- Because faith is understood to be a belief process, a self-striving or effort of the will, failure to attain the desired wellness through one’s own effort may cause depression and self-doubt, leading to a “blaming the victim” mentality. One patient put it this way in a letter to her nurse that was read only after her death, “Please forgive me. If I only had enough faith, I would still be alive today!”
- Often nurses and hospitals do not require a patient’s informed consent for alternative therapies.
- A clear violation of professional ethics occurs whenever nurses use (alternative therapies) without the patient’s consent. . . . One nurse describes an incident where she practices therapeutic touch usually inform patients, but practice the technique on patients who are asleep. . . . The ethical issues remain when the patient consents but is not fully informed about rationale or worldview behind the procedure. By relating therapeutic touch to the [Christian] practice of laying-on-of-hands [for example] . . . the nurse . . . misrepresents the modality and violates the patient’s spiritual integrity.28
- Patients who decline to use alternative therapies, believing the therapies violate their religious beliefs, may discover that their refusal prejudices their care. Such patients have been described (labeled) by nurses as “rigid” and “noncompliant” in chart notes documenting the patient’s refusal.29
- Health update. Better Homes and Gardens. Nov. 1996: 78.
- Medical Ethics Advisor. Nov. 1998 (supplement): 1.
- Salladay S, Shelly J. Spirituality in nursing theory and practice: dilemmas for Christian bioethics. Christian Bioethics. 1997; 3: 29–32.
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- Shelly J. The healing touch. Unpublished paper. 1997: 11.
- Salladay and Shelly, Spirituality in nursing theory and practice.