Determinar el efecto de diferentes toxinas Cry de B thuringiensis sobre S nonagrioides , con el fin de identificar toxinas que puedan ser utilizadas para el

The results indicate that nurses want to (and in fact do) ‘nurse spiritually’ but this was described as needing additional efforts by the nurses. Often spiritual needs were negotiated with the service user. Where the system is restricting the nurses’ efforts and impacting on the service user, often the nurse goes ‘the extra mile’ and there are attempts made to facilitate needs as much as possible.

“How are we gonna squeeze this round peg into this square hole of services? Because it’s not what she values, it’s not how she connects with people. How are we going to

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accommodate that? We have to shave off things of the person to really fit in with the service because the service is unchangeable isn’t it? So we’ve just sort of bashed her in. She’s fraying a bit at the bottom slightly but hopefully we can sort that out when we move her into her own space and she’ll spring back. The team has long discussions about how we can try and accommodate somebody’s spirituality but the organisation

doesn’t” Ann

Some of the approaches participants discussed were about ensuring the person had every opportunity within the constraints of the system to meet their cultural and spiritual needs. Sometimes this might be in a fairly straight-forward manner, for example as in Paul’s quote below, ensuring that service users had what he termed the ‘artefacts’ associated with their religious practice available to them:

“So basically, assessing needs and also having sort of religious artefacts and stuff, within a unit such as this. So having, you know, is the Koran available for them, do they have prayer mats or is there a bible for people that go to church or, is there other sort of,

err, religious artefacts that they need, maybe so that they’re accessible, so they can continue with their spiritual, err, spiritual beliefs, despite being under the Mental Health

Act.” Paul

At other times, addressing spiritual need was described in broader terms. In the quote below, Dawn described how something outside of ‘treatment’ but nonetheless very important and meaningful to the service user was facilitated (with some difficulty on an inpatient unit) by her team:

“We’ve got a lady in at the minute, she’s Afro-Caribbean and she wants her hair doing properly. Our hairdresser who usually comes doesn’t specialise can’t really do it. So we’ve got a woman who knows someone who specialises in Afro-Caribbean hair that

can come in for her and do her hair” Dawn

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Even when caring for the needs of service users in this manner was difficult (and not necessarily an obvious part of their nursing role), participants repeatedly described how they were prepared to make additional efforts to do this.

“Obviously, some people are gonna have things like that are unattainable like, I want to be on a desert island and what-have-you but you’ve got to negotiate what is the best

way of achieving the optimum”

Chris

“I was giving him the only hope, keeping something. He would have had nothing going for him at all, it would have been the end for him. I said I’m prepared to put my job on

the line for you”

Joe

As evidenced in both Joe’s quote above and in Mary’s account at the beginning of this section (where she described how her team provided highly personalised care to ensure that the service user ‘round peg’ could be accommodated in the ‘square hole’ of services), it is clear that participants perceived effective spiritual care as being very much about individuals. It seems that to address spiritual need requires that both the nurse and the service user must engage on a truly human level as real individuals. However, this might mean that the nurse went beyond standard ‘system’ conceptualisations of both their own role and ‘patient’ or ‘service user’, and doing so could lead to a real sense of vulnerability. I will describe the anxiety and fear this may provoke in the next section in which I will address the integrative theme of ‘fear and anxiety’.

Theme three nursing spiritually is concerned with how participants described applying their understandings of spirituality to nursing care. I have identified two broad approaches to ‘nursing spiritually’ (pragmatic and spiritually empathetic). I have also considered factors which influence how participants provide care for spiritual needs.

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Factors relating to the service user which influenced how participants ‘nurse spiritually’ included the service user’s religious and spiritual history, their diagnosis and the setting in which care was provided. I have also explored how participants described their efforts to ‘nurse spiritually’ within the limits of system requirements. I have noted how providing spiritual care might require that participants ‘go the extra mile’ and that this could generate anxiety and fear. In the next section (4.4.4), I move on to examine this integrative theme in detail.