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					Peter Kevern 2011
The Problem:
  Health care workers are reluctant to discuss spiritual
  issues with patients because of concerns about:
 Competence.

 Autonomy.

 Neutrality.
                                     (Curlin & Hall 2004)
This is a particular problem for ‘spiritual
values’ because
(a) By definition, the 'spiritual' is not
  empirical.
(b) as 'values', it relates to matters understood
  to be of core (though not necessarily
  'ultimate') concern.
 So e.g. A nurse who engages in a conversation on spiritual values with a
 patient enters unknown territory, and high-profile cases (such as that of
 Caroline Petrie where a complaint was occasioned by the ‘religious’
 behaviour of a nurse) have increased the sense that it is full of ethical and
 professional pitfalls (Alderson 2009).
One proposed solution
. . . is to find common ground in the conduct of the
   interaction rather than its content (Pesut 2010, Carr
   2010)


But can you have an interaction without
 content? And if not . . .
 Who gets to talk about it?
 And how?
 Religion and spirituality in a secular, European
                     context.

Getting to grips with the issues

Regardless of religious conviction, we all share a context that is

           Secular: a shared belief is not assumed
           Pluralist: whatever we believe, we will encounter others who believe
            differently
Therefore, all our belief is ‘postcritical’ in one of 4 ways
(Duriez & Hutsebaut 2003):
                           Include transcendence
          Literal
          affirmation                              Restorative
          (orthodoxy)                              interpretation
                                                   (second
                                                   naivete)

Literal                        Received religion                    Symbolic



                                                   Reductive
          Literal                                  interpretation
          disaffirmation                           (relativism)
          (secular crit)
                           Exclude transcendence
This provides us with a grid of
possibilities:
Patient >           1. Orthodoxy   2. External      3. Relativism    4. Second-naivete
Nurse v                            Critique
1. Orthodoxy
                           No              No              (No)            (No)

2. External
                           No              No              (No)            (No)
Critique
3. Relativism
                          (Yes)           (Yes)            Yes              Yes

4. Second-naivete
                          (Yes)           (Yes)            Yes              Yes



Possibilities for therapeutically-useful nurse-patient encounter on spiritual values.
 . . . which identifies 4 key groups of
practitioners:
1. Inflexible literalists, who should not be encouraged to
   undertake spiritual care outside their own group !
2. Pragmatic literalists, who subordinate their beliefs to the
   ethics of care, and who may be articulate and competent
   in spiritual care of those who themselves have open
   beliefs
3. Those who have a ‘postcritical’ approach, being clear of
   what they believe but open to others, who may be the
   natural all-rounders and
4. Those who value belief, but sit lightly to it (relativists),
   who may need to be positively encouraged to attempt
   spiritual care.
References
Alderson, A. (2009) Nurse suspended for offering to pray for elderly
  patient's recovery , The Telegraph Online, obtainable from
  http://www.telegraph.co.uk/health/healthnews/4409168/Nurse-
  suspended-for-offering-to-pray-for-patients-recovery.html

Carr , T.J.(2010) Facing Existential Realities: Exploring Barriers and
  Challenges to Spiritual Nursing Care Qualitative Health Research
  20:1379–1392

Duriez, B. and Hutsebaut, D, (2003) A slow and easy introduction to the
  Post-Critical Belief Scale: Internal structure and external relationships
  in Hutsebaut, D. Handbook of the Psychology of Religion

Pesut, B. (2010)Ontologies of nursing in an age of spiritual pluralism:
  closed or open worldview? Nursing Philosophy 11: 15-23

				
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posted:10/14/2011
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