Spirituality, Cultural Competence and Safeguarding in Adult Nursing

In this essay there will be a demonstration of key principles in relation to spirituality, cultural competence and safeguarding, with application to an adult nursing practice. Factors that may influence nursing interventions when caring for a patients spiritual, cultural and safeguarding needs.

Spirituality in Nursing

Spirituality has been defined as ‘a personal search for meaning and purpose in life, which may or may not be related to religion’ (Tanyi 2002, p. 690), this idea of spirituality is further supported by Murray & Zentner (1989: p. 259) who state that this “spiritual dimension… comes essentially into focus in times of emotional stress, physical (and mental) illness, loss, bereavement and death.’ Ellison (1983) suggests that spirituality ‘enables and motivates us to search for meaning and purpose in life.’ In addition, authors such as Walsh (1999) have suggested that in comparison to spirituality, religion involves an organized entity and has definable boundaries and may provide guidelines to which individuals adhere, this has further been argued by Miller & Thoresen (1999) as therefore taking away from that personal search for meaning and purpose, due to adherence to religious practices and beliefs.

Individuals such as Swinton (2001) have explored the importance of spirituality in regard to the health of a patient as he found strong positive correlations with symptom reduction in health conditions such as,” depression, anxiety, addictions, suicide prevention, anorexia and schizophrenia” (Swinton, 2001, p. 68). However a limitation of this research is it’s difficult to measure the human spirit as an independent variable, although individuals such as King et al (1995) have suggested that the impact or importance of a spiritual belief to life and its effect on behaviour can be measured through the use of a standardised interview; Royal Free Interview for Religious and Spiritual Beliefs. Research implemented by authors such as Nolan & Crawford (1997) show that this attention to a patient’s spiritual needs can have increasingly beneficial effects for the individual, including spiritual growth, new insights, new interpretations of personal situations, a new vigour in professional practice.

As well as this further importance of spirituality in nursing is shown throughout The Nursing and Midwifery Council (NMC, 2018) code as it states that those receiving care should be treated without discriminatory attitudes and with respect and with their rights and beliefs being (National Health Service, NHS,  2012), this includes working within a multidisciplinary team to ensure that the all the individuals needs are met including spiritual. Spiritual care is important in regard to high dependency care settings, as Silva and Pereira (2011) found an excessive preoccupation with the technical care, leading to stress among professionals which can become acute and chronic, there is the concern of nurses suffering in the occurrence of the family’s loss within a palliative setting. Therefore, taking spirituality into account is important in order to unify scientific knowledge, in practice, with an expression of human sensitivity and a deep awareness of the human being (Desorzi and Crossetti, 2008).

In conclusion there is a responsibility as health care professionals to respect and individuals’ rights and beliefs (NHS, 2012) when undertaking personal and medical care, this is having the professionalism to take on an unbiased perspective that aids the individual to have a positive impact on their health, (Swinton, 2001). The care implemented must be holistically adjusted to ensure that spiritual needs are met, this can be done through a research tool as highlighted by Nolan & Crawford (1997).

Cultural Competence in Nursing

Cultural competence within nursing can be used to reference a, “multi-cultural knowledge base that nurses need, together with the ability to apply such knowledge in practice” (Jirwe, Gerrish, & Emami, 2006, p. 6). Furthermore, in relation to nursing, Papadopoulos (2006) defines culture as “the shared way of life of a group of people that includes beliefs, values, ideas, language, communication, norms and visibly expressed forms such as customs, art, music, clothing and etiquette. Culture is an element that has an impact on people’s health-related beliefs and behaviours and therefore is an important factor to take into consideration in a care setting. According to Leininger (1995) a way to provide culturally competent care, is for nurses to build a rapport with their patients and therefore develop understanding of the cultural backgrounds of each patient.

Culture has an impact on people’s health-related beliefs and behaviours and therefore it is an important factor when caring for a person from a culture different. Culture as explored by Kleinman & Benson (2006) can usually lead to stereotypical attitudes, cultural misunderstandings, prejudices and discrimination.

Papadopoulos, Tiki and Taylor focused on a model for developing cultural competence (Papadopoulos, Tiki and Taylor, 1998). The model was developed with four categories with the aim to provide effective health care that takes the patient’s cultural beliefs, behaviours and needs into consideration in the nursing process. The four categories being; cultural awareness, cultural knowledge and cultural sensitivity as components of cultural competence. Gerrish and Papadopoulos (1999) highlighted the importance of developing these culturally generic competencies throughout professional care as they are applicable on a broad-spectrum pf cultural group. Papadopoulos (1999) argues that these competencies help us become ‘culture-specific’, particular to specific cultural groups, for example how cultural identity mediates for health. In comparison a theory framework outlined by Ramsden (2002) based on Negotiated and Equal Partnership Model (Cooney, 1994; Coup, 1996), claimed that cultural safety should be seen as a partnership between the patient. Culture-specific knowledge is not emphasised within Ramsdens model as the risk for stereotyping is higher and an issue found within Papadopoulos’ , Tiki and Taylors model (1999), although this research was outlined in New Zealand and therefore its cultural validity may be unreliable.

A challenge when delivering cultural competence within nursing according to research found by Culley (2008) is that nurses become ’experts’ in cultural knowledge in regard to particular ethnic groups, thus leading to negative stereotyping, this in turn leads to a checklist approach to cultural diversity (Culley, 2008). However theoretical frameworks developed such as Papadopoulos, Tiki and Taylors’ model (1999) helps minimise this risk as it looks at cultural sensitivity as a category and highlights the importance of having an equal partnership which will allow negotiation, and therefore challenge these stereotypes on a person to person basis, further supported by Dalrymple and Burke (1995) who emphasises this necessity for culturally sensitive care.

In conclusion, due to the need for culturally competent and diverse nurses, nurses must have the knowledge of how to become culturally competent. To undertake this challenge, nurses must understand cultural competence; what cultural competence is, what comprises it, and how to incorporate appropriate cultural care in a health setting, which can be done through the use of frameworks such as, Papadopoulos’ Tiki and Taylors and Dalrymple and Burke (1995).

Safeguarding in Nursing

Safeguarding as described by The Royal College of Nursing (RCN, 2019) is having services and all health care professionals responsible for implementing care that ensures an individuals’ safety as well as highlighting the importance of these “professionals and organisations working in partnership to protect children and adults in need” (RCN, pg.1, 2019). The Nursing and Midwifery Council (NMC, 2018) The Code, also states that it’s a professional duty to raise concerns if an individual is vulnerable or at risk and (17.1) “protect people who are vulnerable or at risk from harm, neglect or abuse”. In order to ensure safeguarding is bring implemented its important in accordance with the NMC (NMC, The Code, 2018) to keep updated with relevant laws and policies in regard to caring and protecting vulnerable people.

The Human Rights Act (1998), supports the importance of safeguarding throughout health care as it defines abuse as “a violation of an individual’s human and civil rights by any other person or persons”. This act states the responsibility on local authorities, such as, the NHS (NHS, 2019) to uphold these specific rights and ensure that individuals are protected from any behaviour that directly goes against these rights, for example, neglect, malnutrition or poor hygiene. In addition, The Mental Capacity Act (MCA, 2005) also sets out legalised framework in place to protect individuals who are vulnerable and who do not have the capacity to make decision or a fluctuating capacity, as safeguarding decisions should be made in the person’s best interest. Acts such as, The Equality Act (2010) protects discrimination and unfair treatment of care because of an individuals’ characteristics such as disability, age, gender and sexuality. Nurses have a professional duty to promote equality, ensuring individuals are not being disadvantaged, thus implementing safeguarding.

Safeguarding is an important part of nursing as abuse and neglect can happen, in a person’s own home, in a care home, hospital or any other environment, it is therefore important a nurse knows the correct protocols and is able to recognise when its necessary to report a concern and document when required. If there is a safeguarding concern, it’s important that the professional in charge knows who to contact this might be the duty or out-of-hours team in the local authority, or the police in the public protection unit when a crime is alleged. Nurses also need to understand how to communicate effectively (6cs, NHS, 2018) with a patient so that they have a rapport and the individual feels safe confiding in them, for example, nurses when discussing a safeguarding concern should not ask leading questions when abuse is disclosed as this may cause further issues that are not warranted.

Overall, it is a nurse’s professional duty to ensure that any safeguarding concerns are raised and that they are able to recognise when an individual is in a situation that requires further escalation, and the correct procedures to report these concerns e.g. The Human Rights Act (1998), The Mental Capacity Act (MCA, 2005).  Legal frameworks should also be taken into consideration and the rights individuals are entitled to.

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