Having been a nurse for 29 years I am looking forward to beginning my 4th decade in healthcare. During this time I have forayed into Yoga, Reflexology and Aromatherapy, as well as the more traditional health programmes, one thing that has continued to fascinate me is the impact of the individual and their beliefs, as well as caring for the spirit as well as the body. 
I am starting this blog to share my thoughts and to encourage more understanding of the importance of knowledge particularly in Palliative and Dementia care. 

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Spirituality - its meaning 

Spirituality is not a term that can be easily defined as many terms can. The Oxford English Dictionary defines spirituality as: 
1. ‘The quality or condition of being spiritual; attachment to or regard for things of the spirit as opposed to material or worldly interests’ 
2. ‘Spiritual character or function’ 
3. ‘A spiritual thing or quality as distinct from a material or worldly one; a pious remark or saying’ 
 
Historically the word has been used to refer to ‘An immaterial or incorporeal thing or substance; a spirit’ giving it a much closer relationship to religion than generally assumed today; here, the word ‘spirit’ suggests an entity in its own right. Today many words are used almost interchangeably, spirit and soul, are examples of this; each has distinct meanings in the languages they originate from. ‘Spirit’, meaning ‘breath’ in Latin, ‘Soul’ meaning ‘sea’ in its original Germanic routes, (although it is more widely accepted that its origin is from words meaning life or salvation). Today the word spirit is often used to refer to transcendence and the word soul to refer to ‘the meeting place between spirit and the body’. 
 
Much has been written on the role of spirituality in health and particularly Palliative care, McSherry discusses how religion describes the ‘breath of life’ given by ‘Yahweh God’ as being the essence of man, making man a living being and separate from the rest of the animal kingdom (Book of Genesis (2:7)). One common theme is the idea that nurses need to be involved in spiritual care, it is however a theory advocated only in ‘secular care facilities of the English speaking part of the Protestant world’. 
 
Dame Cecily Saunders has often been credited with the introduction of spirituality, in its ‘search for meaning’ definition into palliative care after reading Frankls’ ‘Man’s Search for Meaning’, Frankl considers spirituality and its importance to people in extremely traumatic situations, after his experience of Nazi occupation of Europe. He coined the term 'existential search', usually replaced today by spiritual search. The term existentialism is defined as a philosophical theory or approach which emphasises the existence of the individual person as a free and responsible agent determining their development through acts of free will, a theory that was developed during the early 20th Century, by amongst others, Sartre. This definition has no reliance on an all powerful, Godlike figure, responsible for directing moral judgments and decisions, although when used in religious theory, it will be demonstrated as the path leading to God. 
 
Formal religions provide a framework by which to live, a set of practices as well as a formal support system to provide ‘resolution of past and present dilemmas’. The Coping with Cancer study, found that in patients with advanced cancer and a prognosis of under 1 year, 68% stated that religion was of great importance to them , and that there was a direct correlation between the level of patient distress and their ‘religiousness’ . The study also ‘noted that private daily religious activities such as prayer and meditation increased from 46% before diagnosis to 61% after’. However, while religious beliefs do have a role in promoting hope, many patients report ‘no newly found religion’ and do not want to be ‘judged or forced in to religion’. A theory as to why we turn to religion when faced with our own mortality, includes the dimensions of belonging, the language and rituals that give comfort, a tradition of meaning provided to us during childhood, for example, many couples choose to marry in a religious ceremony but they would not usually describe themselves as religious. 
 
In ‘ Man’s search for Meaning’ Frankl discusses the situation where man has lost guidance on his behaviour (possibly religion and tradition) and now has to make choices, he describes this as an ‘existential vacuum’ that must be filled with meanings or experiences that are individual to him. This theme of individuality is something that 
differentiates the contemporary view of spirituality from the traditional view held by most world religions. Today, the ‘Traditional, orthodox spirituality, the human being in relationship to God, has been replaced by a conception of spirituality as a personal and psychological search for meaning’. 
 
To finish this section consider a definition of psychological, taken from the Greek word psyche, meaning ‘soul, mind, and self, and also ... a butterfly’. 
 
• Edwards, A., Pang, N., Shui, V. & Chan, C., 2010; The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research, Palliative Medicine, 24(8), pp 753-770. 
• Frankl, V. E., 1924 (1992 Edition); Man’s Search for Meaning, Random House Books, Kindle Edition 
• Kellehear, A., 2000; Spirituality and palliative care: a model of needs, Palliative Medicine, 14;149-155 
• Moore, L. H., 2009; Speaking of Dying, Jessica Kingsley Publishers, London 
• Richardson, P., 2014; Spirituality, Religion and Palliative Care, Annals of Palliative Medicine, Vol. 3. No.3 [online] http://www.amepc.org/apm/article/view/4175/5059 (accessed 23/4/15) 
• Walter, T., 2002; Spirituality in palliative care: opportunity or burden?, Palliative Medicine, 16 (2), pp. 133-139 
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