INTRODUCTION
The holistic view of the human being as a unity of body, soul and spirit [1] requires a definition of these terms. According to Barbosa da Silva [2], one way of defining the body refers to the organism, the physical dimension of man, which has the following quantitative characteristics: “is visible, has volume, weight, and extends in time and space , manipulability and quantitatively measurable. As a biological organism, human beings are quantitative wholes that interact with nature, particularly the ecological environment.” By soul we mean “that part of human life that goes beyond the purely organic, cannot be manipulated, cannot be measured quantitatively, and which different responses, social relationships, emotions, perceptions, behaviors, actions, different needs, and ways of satisfying them. Frankl [1] defines the soul as “the human being in its entirety” (pp. 18-27).
Spiritual needs and spirituality are often mistakenly equated with religion. Greenstreet [3] states that in the context of nursing, spiritual needs and spirituality should be viewed as a broad term that includes, but is not equated with, religion. The fact is, however, that no one can define spirituality precisely [4]. This is not to say that spirituality as a human phenomenon does not exist in the context of care. Kevern [5] proposes that spirituality concerns issues of values and meaning that are fundamental in the search for meaning in life [3]. Spirituality is always considered to have moral or aesthetic value [4]. As Timmins and McSherry [6] point out, spirituality is embedded in the core values of daily nursing practice and not something added on. Also, one cannot be a nurse without at some point encountering the human spirit and knowing something about spirituality. In an illness situation, people are likely to reflect on spiritual values to alleviate suffering[7].
Swinton and Pattison[7] criticized the breadth of spirituality in the nursing literature as being too inclusive, commenting that all that spiritual care should be called simply good person centered care. Furthermore, these authors emphasize that searching for the essence of spirituality in nursing is futile, since the meaning of spirituality evolves from specific circumstances and can therefore change. A number of reports [6] criticizing nurses for not providing care based on compassion, dignity and moral integrity can be explained by too much focus separating care morally and aesthetically from the spiritual dimension medical, physiological, and technical issues.
In an overview of nursing research on spiritual care, Ross [8] identified elements of spirituality including faith, meaning, love, belonging, forgiveness, and connectedness. Dalby [9] examined the meaning of spirituality in relation to aging and identified the following themes: integrity, changing relationships with others and with a transcendent being, and coming to terms with death.
In a conceptual analysis Tanyi [10] viewed spirituality as broader than religion and encompassed people’s search for the meaning of life. The definition that emerged was: “Spirituality is a personal search for meaning and purpose in life, which may or may not be linked to religion. It involves connection to religious beliefs, values and practices that give meaning to life and thereby inspire and motivate individuals to attain their optimal being” [p. 506]. Here spirituality seems to be viewed primarily in an existential sense.
Stoll [11] described spirituality as: “Who I am – unique and personally connected to God. This relationship with God is expressed through my body, my thinking, my feelings, my judgments and my creativity. My spirituality motivates me to choose meaningful relationships and pursuits. Through my spirituality I give and receive love; I respond to and appreciate God, other people, a sunset, a symphony and spring. I am pushed forward, sometimes in pain, sometimes in spite of pain. Spirituality allows me to reflect on myself. I am a human being by virtue of my spirituality—motivated and empowered to appreciate, worship and commune with the sacred, the transcendent” [11 p. 9]. According to these definitions, all human beings are spiritual beings and do not have to be religious to be spiritual. Spirituality is individual, includes relationship components and the search for meaning and purpose in life.
Despite a large number of reviews on spirituality, for example in the context of palliative care [12], care management [13, 14], recovery after surgeries [15] and spiritual needs [16] there is ambiguity in research about different perceptions of spirituality and spiritual values in the context of care, which is therefore the subject of this study.
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