Spirituality and Nursing Care: Challenges and Perspectives in the Context of the Health-Illness Process



Spirituality is an issue that needs to be addressed in practice and in health education. This is an actuality article which aims to reflect on spirituality in the context of the health-Ilness process. Noteworthy are the two main challenges in the apprehension of this object: its theoretical definition and its applicability in health care and nursing scenarios. Spirituality is configured as a construction of meaning and relationship to oneself, with others and with the Transcendent. In this context, nursing care is to be-together to creation a new sense space.

Keywords: Spirituality; nursing care; health-disease process; nursing.




Nursing is characterized from a continuous encounter with the daily life of human existence, ranging from the more mundane situation, such as stimulating physiological eliminations, up to the more complex, maintenance of life in contexts of intense aggression. Due to this characteristic, which has already been shown in previous studies1, meaningful and authentic presence of the nurse as a proper form of nursing care which can meet the needs of different dimensions that humans have? In situations of chronic, incurable diseases and the coping process of death, the certainties that supported behaviors and organized a network of logical thinking towards the world may collapse or be re-dimensioned. Therefore, it is considered that the presence of nurses can be configured with a time/space conducive to the development of meanings which terminate at elements such as hope, comfort, harmony, balance and encouragement, even in contexts of strong anxiety and stress. The care implies a being-together that even the cover biomedical science, re-dimension the technique aiming at enhancement of human capabilities in the sense of expression of the very essence of the subject in question, which does not reject the suffering and/or death, but extracts, these experiences, awareness of the vulnerability of the human condition and man's ability to always go beyond the limits of objective conditions.

In the art of promoting health or following the health-disease process, the nurse has in front of them, a being who, on one hand, can be characterized as a knot of events, directions, meanings and stories towards themselves and for the other, has the ability to open up towards others and especially to the Divine as the ultimate reality to which they revert to when absurdity becomes tangible in their daily lives. With this, it is desired to reaffirm that the human being is both stuck to their more concrete reality, and every day, at least in part, determined by their historical and social conditions, and open to a greatness that touches the transcendence and transforms, in some situations, and timeless in addition to its space. When, at birth, someone has a particular nationality, has a certain degree of instruction, belonging to some economic class or has a specific genetic makeup is necessarily tied to some concrete conditions for their existence and free from others. At the same time, even in adverse conditions emerge, over the centuries, people who, rooted in their realities present themselves open to becoming human and thus the capacity to reach out to the others and their needs with deep empathy, sensitivity and generosity, such as Siddhartha Gautama, Hélder Câmara, Viktor Frankl, Mahatma Gandhi, Martin Luther King, Nelson Mandela, Mother Menininha of Gantois and many others that could be cited.

This phenomenon of human openness to a transcendent reality toward becoming one desired but not yet experienced, want to deepen here, specifically, the element of spirituality.


Regarding spirituality and its approach to healthcare itself, two challenges appear in the first instance, one is theoretical and the other of a practical nature. From the theoretical point of view, for those that fall on the horizon of health sciences, the topic can be configured as difficult to grasp as it is located in the middle of several other disciplines such as philosophy, theology, anthropology and social sciences. In addition, highlights the high degree of subjectivity present in their lives, especially in the process of illness and/or death2. Allied to this, the spiritual dimension is not easily understood by objective methods of contemporary western science, which makes it difficult for its insertion in the education institutions as part of the curricular structure of undergraduate and graduate courses in health.

This fact becomes even more serious because spirituality does not have a narrow concept and is not accepted by the scientific community. In a study carried out during the years of 2010 and 20113 , it was found that the most frequently used definitions related to spirituality: such as what gives meaning to life, that, literally, gives life to life, something broader and different from religion, a time that a person may not be religious but have profound spiritual experience4; as a dimension that provides growth in the various fields of relationship, namely, that intra personal, engendering feelings such as hope and altruism, in interpersonal, providing tolerance, unity and a sense of belonging to a Group, and the trans personal field, with a superior being4; as an innate tendency toward God or a higher power, which appears in a search for meaning and transcendence of life5; as an attitude, an internal action, an extension of the conscience, a contact of the individual with feelings and thoughts, as well as the strengthening and maturing that this contact may result for the personality3; as a personal dimension related to the search for answers to the fundamental questions about life and its meaning, as well as on Relationship with the sacred or transcendent, which may or may not culminate in the development of religious rituals and training of community6; may be considered, in order, as the living according to the spirit and, therefore, it is a constitutive dimension of every human being, assigning its entirety such as meaning and vitality7.

Thus, when analyzing the common elements that characterize the academic production on spirituality, at least three points can be seen: the meaning of life, relationship and transcendence3. From this tripod there has been an approach to the concept of spirituality, as the exposed following: a set of practices, attitudes, values ​​and feelings born of the relationship with oneself, with others and with the divine human, giving meaning to life and the personal stories, influencing and being influenced by factors such as; social, cultural, biological, psychological and religious. Recognizing that this approximation shows that comprehensive and still little heuristics for the studies in general and for nursing in particular, some key points of its constitution must be highlighted: the man is, in himself, a nodal point or the intersection between the concreteness of their existence and the transcendence of any kind of religious belief; and in him that the reality acquires precise contouring in terms of significance for the continuity of his life; and he that implements his path in the world, even if it considers that his freedom is always on and that is, at the same time, subject to the constraints of various species that prevent or direct your options; the relationship with the other and the different And, by itself, one of the main components of the man and the woman, finding, including, on the basis of their evolutionary process throughout its history temporally marked; and in the body, mind, heart, subjectivity and the ideas of this same man that the divine reality and can be experienced, corroborating the idea present in the theology and philosophy of which the transcendent cannot be seized in himself, but only mediated by the world and by being himself in that the experience; therefore, the spirituality necessarily requires a behavior of relationship and a be, vis-a-vis, with himself, with the world and with that reality called intangible divine, sacred or transcendent, without necessarily the intermediation of a Religion; therefore, this relationship can be diagrammed as an arrow toward himself and another, as a continuation of the first, that extends to infinity. Between these two poles can be found arrows in all directions that make explicit the ability to be together, to influence and be influenced in so far as it is lived and coexists with the same in a horizontality; and the need to consider that, by more profound than is the interiority of the human being, it is situated in a time and space, where the structures, the knowledge, the standards and the social ideas and societal influence at some time and the define in other, configuring it, then, as filters that will retain or release facets or dimensions of which we can consider as spirituality.

The discovery of the capacity ratio in several directions as an exercise of the spirituality and the presence of the nurse as the founder of a space of freedom for the construction of the meaning that help to build new perspectives about the world, about himself and his life are elements that intersect as possibilities for a new understanding of the health-disease process and the man who incessantly confronts different healthcare institutions. This meeting of potentials and relational capacities between nurses and patients requires an ethical imperative to care beyond the biological and pathological demands and, in this direction, the exercise of spirituality - that must be continuously stimulated - may be increasingly necessary, even with the and progressive diminution of vital energy present in a body. Here it is considered to mitigate the hegemony of scientific knowledge and the power that this confers on the basis of the possibility of a dialog that promotes the multiple possible relations to the most complete realization of the human being who is under the care of a nurse.

Nursing care that carries in its interior, spiritual care as one of their many concerns, allows a successful result, the organization of the daily work of nurses is their demands de-centers from the biomedical in view of capturing the human dimensions that promote the dignity and encourage hope, under which anyone feels citizen of a country, a nation and valued by belonging to a common destiny. In addition, when the communication, in its various forms, is no longer possible, given the advanced stage of organic dysfunctions, it is believed that the nursing care in its spiritual dimension can also offer comfort and sense to understand the nature of the inevitable process of death in some cases and the human growth in this context. In this sense, one cannot fail to mention the reports collected in that the patients who returned to experiences of almost death describe the importance of this care at the exact moment in which are considered clinically dead8, nor ignore the traditional study of nursing in which the care was characterized as trans-dimensional9. If, nonetheless, if you want to avoid being in this place difficult to objectification objective methods of current biomedical science and thus understand that these statements cannot be considered completely valid for the entity that bids farewell to life, they, in a way Overall, it has been for the families that make their reports in the post-mortem, indicating how much contributed to the construction of a sense of life and a state of comfort in extreme situation between life and death of their loved ones.

The practical challenges, we must now address, appear in the wake of some theoretical difficulties listed in the preceding paragraphs. The non-precision of the concept and its inviolability configure as challenges for the seizure of spirituality as a concrete dimension and detectable of nursing care, such as the realization of technical procedures. In addition, the definition of some more general contours of spirituality as something that can be objectified, with a certain degree of homogeneity in each institution, it is also shown but difficult to achieve. At this point, it should be recognized that spirituality is a complex phenomenon by nature, in so far as it is perceived that their essence and cause the human being the expression of their uniqueness in the context of the health-disease process and in the midst of the institutional context, with all that this context requires of technologies, processes, and resources.

Regarding human resources, one must consider the very spirituality of professional influence on the perception of what is happening around them, including the spirituality of patients and their families. It is urgent to identify elements of spirituality that can be observed and followed in a more systematic and objective within the health units, especially the hospitals where the absurdities of existence tend to make themselves more present. Is worth noting that, if spirituality itself is hard to be understood, its elements, expressions or aspects can be accessed. Such aspects include search and finding the meaning to life; affective relationships associated with meeting regard; feelings like love, hope, motivation, and their own religious practices themselves, translated into outward manifestation of their beliefs and spiritual state10,11. Finally, one last question to be scored here, although the subject has not been exhausted in its depth: the need for institutional arrangements that, in a rational and organized religious practices of different hues can be carried out in health facilities such as form of health care and nursing, comfort and developers stimulator of human dignity in its birth, grow, develop and die. In most cases, religious practices can make this concrete relationship with the totality of being and human dimensions that the idea of spirituality alone can subtly pass, given the difficulty of its concreteness in the daily life for patients and professionals. These practices, by themselves, provide a better delimitation and relational colorful arrows to the aforementioned.

If there are obstacles to the achievement of the appreciation of the spiritual dimension of the human being in health care and nursing, on the other hand some steps are already being taken towards a new perspective of care. Currently, there has been an increase in the scientific publications on the triad of spirituality-health-disease, with revealing results, especially in the prevention of diseases and the rehabilitation of health4,12. In this context, we highlight the participation of nurses as authors, assuming expressiveness in the ranking of these productions13,14.


Without claiming to answer the questions in the text, since they are much more provocative than even the organizers, the study highlights the urgent need for spirituality in the context of health, is deemed as one of the human dimensions that influences so directly, in the way the subjects are placed in front of life and limit situations faced in the course of their life. It is not presented as the sole element, but contributes to the human being, in their vulnerability ontological, stretching beyond the pain and construct meanings fundamental to the absurd faced suffering, illness, separation and death.

It is in this sense that it insists on the genuine and significant presence of nurses, dating back to its own historical building whose ideal concentrated on ethical dimension-moral-spiritual, as one of the factors that can stimulate the overcoming of desperate moments. This overcoming is related to the exercise of spirituality as a relationship that capacity does not exclude the darker side of human existence, nor the most colorful paints, but allows the humanization process develops along this trajectory, generating a slight hope that stimulates human creativity and enthusiasm, as true embers under the ashes.

In this way, the transcendent can be presented as instance that allows the visualization of the human potential and possible untested, especially from the enchantment that the human and the divine may be present in the concreteness and along their trajectory in the world, even in the final moments of their existence.


I dedicate this article to the individual, my father, Arlindo Gomes Ribeiro, who made his final Passover on 10/28/2012. Through joy, simplicity, trust, love, faith and hope. But above all because he knew how trace his way through the world with originality, flexibility, lightness and courage. He is now experiencing in the place the reality which he believed in, feeling as light as a boy flying his kite amid the constant winds of August.


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