Issues on Spiritual Care Practice

First of all, as cited by Casarez and Engebretson, (2012) there is no consensus about the exact meaning of spirituality. When this word is examined etymologically, it appears that is a combination of Hebrew words 'ruah' (breath, breeze, air) and 'nephesh' (essence, vitality) (Reese 1980). In this article, word will be used specifically to mean the religious activities and rituals like frequently used recent times. Spirituality is a widespread concept which has been distinguishing in different forms in various cultures since the past (Sawatzky & Pesut 2005, Sesenna et. al. 2011) as cited by Casarez and Engebretson (2012). However, as a common point within such diversity, spirituality is constantly associated with the physical and especially the psychological states of people. People often interpret and perceive their experiences, such as healing or sickness, through spirituality. Since the early years of the twentieth century, with the influence of technological and scientific developments, secularism has begun to dominate the areas where spirituality and religious prevail in the past. (Casarez & Engebretson, 2012; Larimore, Parker, & Crowther, 2002). Religion and science have been launched by academia and science committees as two concepts that are completely different from each other, although they deal with the same issues. Indeed, being religious for people caused negative labeling, such as thinking illogically or being emotionally disturbed (Larimore, Parker, & Crowther, 2002). This rapid secularization in the areas of mental and physical health has been severely criticized both by the public and by some scientists. Some of them have mentioned that focusing on the spiritualities and religious orientations of the patients will provide comfort to them, it will be good for their health and healing process, and that the patients have the right to be preferred in this way (Sloan, Bagiella, VandeCreek, Hover, Casalone, Hirsch, & Poulos, 2000). In the face of these opposing views, ethical issues naturally appeared. As a result of related literature searches, there is not much publication yet. Published resources mostly focus on medical workers, physicians, and nurses in medicine. Mental health workers, such as social workers and psychologists are referred to quite superficially (Carson, 1989; McSherry, Gretton, Draper, & Watson, 2008; Wright, 1998).

In general, spiritual care intended to support the patients, who have deep concerns that they cannot share anyone. The first step is applying apply spiritual assessment to the patient. Depending on the level of volunteerism during the assessment and first interview, the patient could be scheduled for an oncoming interview ("Spiritual Care," 2003). Stoll (1979) identified four main questions for this spiritual assessment. The first of these, what is the meaning of God or deity according to the patient, and how important this concept? Second, what are the sources of strength or support that the patient receives during moments of spiritual crisis? Third, what are the religious practices of the patient and how much is the effect on her/his lives? Finally, the fourth is how the spiritual beliefs of the patient relate to her/his concepts of illness, health, and death. At this point, it is unlikely that the interviewer is should be a neutral observer. As a matter of fact, this seems impossible. Because religion or spirituality are abstract concepts that significantly vary from individual to individual. As an understandable example, while the patient finds his religious beliefs very strong, the consultant can think of the exact opposite. There is no objective average attitude or behavior in such circumstances. Although there are a number of widespread religions or spiritual beliefs that are widely spoken around the world, they are almost as diverse as people who believe in them. For example, religious communities, sects, organizations and many other forms could arise from only single religion. Therefore, it is inevitable for the practitioner to make an evaluation of his / her personal opinions that means personal views and professional work coalesce.

 According to American Psychological Association (APA, 2010) ethical codes, professional and personal relationships must be separated from each other in two different areas. APA has made it clear that this is the subject under the title of multiple relationships. It is contradictory in the professional area that the practitioners open personal opinions on such a sensitive subject. This will affect the objectivity, efficacy, competence and functional performance of the interviewer after a while. In such a case, after a period of time, the difference between the position of the client and the practitioner will gradually decrease and eventually be equalized. Therefore, spiritual care practitioners have to conduct negotiation between social, personal and professional roles and behave in the frame of ethical rules (Pesut & Thorne, 2007).

American Psychological Association asserts five general principles before the ethical standards. These are beneficence and nonmaleficence, fidelity and responsibility, integrity, justice, respect for people's rights and dignity. The question of spiritual care will be seen as encountering many issues when addressed within the frame of these general principles. First, it is necessary to know that the overall intention of principles is ‘not harm'. In this respect, need to be fully aware of the feelings, thoughts and the patient's past spiritual experiences. Unfortunately, it is not possible for practitioners to meet objectively these conditions in recent times. Because, science deals with the phenomena that are observable and testable, but spirituality does not fully meet these conditions by reason of it is a very personal as mentioned before. It is largely related to patient's inner world rather than to the cognition. Otherwise, it would have the potential to hurt the patient emotionally and damage the system of values they have built over many years. In order to analyze the spiritual state of the patient, there is no available specific imaging system like FMRI or a scale which is tested in terms of validity and reliability. Even if there were suitable instruments it was inevitable to encounter methodological problems similar to those in emotion studies. For example, it is unfortunately not expected to give a very reliable result in a study lab environment about how sincere the patient is (during how much he is really being alerted) during a religious ritual.

To sum up, the spiritual states of persons could not be factually determined, and the obtained objectively given light could not be evaluated. This means that the spiritual carer directly uses his or her own personal experience and ideas as a measurement and evaluation tool. In this regard, this issue poses ethical problems in two different directions. First, this is clearly stated under the third title, 'Human Relations', of the section on Ethical Principles of Psychologists and Code of Conduct that American Psychological Association publishes (APA, 2010). According to the statements, professional and personal boundaries must be clearly drawn and separated. Second, it is related to 'do not harm', which is the general emphasis on five ethical principles (APA, 2010). Therefore, interpretation of information obtained subjectively by the spiritual caregiver without any scientific basis could seriously unsettle the personal value judgment of the patient. In such a case, the patient probably gets harm, as well as the practitioner, will take too much responsibility.

Another question about spiritual care concerns the level of competence of the caregiver on the subject. While spiritual care has recently become a striking issue, there is not much talk about the training equipment of those who will be employed in this area.  This is indicated also under the second ethical standards ‘competency' in Ethical Principles of Psychologists and Code of Conduct (APA, 2010). Spiritual care has recently become a striking issue, and there is not much talk about the training equipment of those who will be employed in this area. After a short survey on the internet, several weeks of simple training and spiritual care specialty certificate programs are striking. The capital system, the chief driver of consumer culture, quickly adopted the idea of consuming people's beliefs. This easily observable situation has become the main agenda of experts working in the fields of human and social sciences in recent years. Exploiting, immobilizing, or directing people through spirituality is a popular way of recent times. Politicians, especially those who have not acquired the conscience of professional ethics frequently resort to this path. Spirituality is a very comprehensive issue, from any angle. In this way, the question of how to be competent with education is a big question. Formalities of training and certifications undoubtedly have any real sense.

References

• Sloan, R. P., Bagiella, E., VandeCreek, L., Hover, M., Casalone, C., Hirsch, T. J., ... & Poulos, P. (2000). Should physicians prescribe religious activities?. New England Journal of Medicine, 342(25), 1913-1916.
• Carson, V. B. (1989). Spiritual dimensions of nursing practice. H. G. Koenig (Ed.). Philadelphia: Saunders.
• McSherry, W., Gretton, M., Draper, P., & Watson, R. (2008). The ethical basis of teaching spirituality and spiritual care: A survey of student nurses perceptions. Nurse education today, 28(8), 1002-1008.
• Wright, K. B. (1998). Professional, ethical, and legal implications for spiritual care in nursing. Journal of Nursing Scholarship, 30(1), 81-83.
• Stoll, R. I. (1979). Guidelines for spiritual assessment. AJN The American Journal of Nursing, 79(9), 1574-1577.
• Spiritual care. (n.d.) Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. (2003). Retrieved November 12 2017 from https://medicaldictionary.thefreedictionary.com/spiritual+care
• American Psychological Association. (2010). Ethical principles of psychologists and code of conduct (2002, Amended June 1, 2010). Retrieved from http://www.apa.org/ethics/code/principles.pdf
• Pesut, B., & Thorne, S. (2007). From private to public: negotiating professional and personal identities in spiritual care. Journal of Advanced Nursing, 58(4), 396-403.