Diversidad de tripsinas

In this section, I will consider how the integrative theme ‘fear and anxiety’ was apparent in discussion of the care of service users. I will focus on two related issues in relation to ‘fear and anxiety’: ‘imposing beliefs’ and ‘difficulties in reconciling the nursing and evidence based approaches with spiritual approaches’.

‘Fear and anxiety’ in relation to imposing one’s own beliefs could be in relation to imposing either specific religious beliefs or a standardised model of care or ‘wellness’ that was not appropriate for a particular service user. Participants widely expressed the view that imposing a particular set of beliefs on a service user was a bad idea, and were particularly explicit about this in relation to religious belief:

“We have a gentleman who used to work in our place who was a very spiritual person and he used to speak a lot about his views. I can’t remember which specific church it was but he used to tell people how he used to talk in tongues at a service. He doesn’t work here anymore because a lot of the service users asked not to see him again. They

were using terms like ‘he freaked me out’ and things like that. Or he was pushing his view on them so I think staff are hesitant about him. I would never push something. I

wouldn’t push any spiritual ideas that I had on anybody else. Harry

“There is a danger with some people of imposing their own beliefs and causing extra distress. Understand them from their perspective, possibly question their beliefs but not

impose any beliefs” Joe

“As a nurse I would be reluctant to impose anything that I believed on them because I don’t see it as my place to impose something you know?”

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Whilst some of the nurses stressed their fear of imposing spiritual beliefs, other participants stressed the importance (and difficulties) of ‘putting to one side’ those beliefs’. They emphasised there was seemingly a need to recognise and acknowledge one’s own beliefs whilst avoiding imposition:

“You know you obviously need to know your limitations. To not carry too much with you in your practice and take your own beliefs about religion and judge other people by what

they’re doing in their lives and that’s completely wrong because you’re not meant to be doing that as a practitioner. I feel I need to know why and I start thinking about it and

then I get anxious because I’m over-thinking things”. Freya

“You are a person who brings all your belief systems, your prejudices and try and pretend that you haven’t got them is probably the most dangerous thing you can do as

far as I’m concerned.” Kate

Many of the participants described how another ‘belief' system – that of evidence based nursing practice following secular western influences often seemed incompatible with providing the type of person-centred spiritual care the service users might need. Lisa, for example, described a conflict between the traditional evidence based nursing approach and what the service user apparently wanted. The service user had been prescribed Clozapine to get rid of her auditory hallucinations. She had experienced auditory hallucinations for many years and had reported that she felt no real distress as a result. However, because she was seen to be floridly psychotic, mental health services had intervened with what they viewed as helping her when in actual fact this was against what she wanted and, according to Lisa, badly affected her ‘spirit’.

“We realised that what we had traditionally been doing our entire careers in trying to rid her of these experiences wasn’t her goal or her treatment outcome”

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The situation Lisa referred to was one of a number of examples in which participants discussed how care was affected when nurses felt obliged to use standard medical approaches. Sometimes, accepted treatment approaches might not be congruent with a service user’s spiritual, religious or cultural preferences as discussed in the ‘nursing spiritually’ theme previously (4.4). Olwyn gave an account of a situation where spiritual and cultural differences caused conflict for the service user and potentially impacted on her treatment and recovery.

“We had a lady whose family felt that she was possessed and they came and did think it was a Jinn, they brought in the Imam and that was really difficult because it seemed like they were making her frightened and that wasn’t helping. It was saying the opposite to

what we were trying to say which was giving her a double message” Olwyn

Conflicting views caused issues with approaches to care and this clearly concerned some of the participants. Participants also expressed concern in relation to distinguishing between what constituted spiritual needs or preferences as opposed to symptoms of mental ill health, as highlighted in 4.3 (nursing spiritually) previously. The following extracts evidence the uncertainty and anxiety participants described facing when making such assessments.

“I’ve often seen people’s differences and the way they think and approach things I think could be potentially misinterpreted, like people’s beliefs being misconstrued and labelled as psychosis or thought disorder, the sense of spirituality does not necessarily

mean that’s not right or not real for that person. Why does it have to be labelled as some symptoms, some element of mental illness, diagnosis?

Dawn

“We have problems with things that aren’t scientific in our society, we used to be very spiritual in our society but it’s moved away from that, then it’s very difficult sometimes accepting people’s spirituality when you feel that it’s damaging the person you want to be helping. If you hear voices in some jungle and you’re a medicine man, you’re revered

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pumped full of meds and we say it’s psychosis don’t we? Who’s to say these voices aren’t real but they are gifts from God or whatever, it’s all so wrong”.

Mary

Mary commented above on how “We have problems with things that aren’t scientific in our society”. Nurses are trained and conditioned to assess in terms of a secular western healthcare models that emphasises evidence based practice. Their fear of ridicule and impact on professional standing (as described in the previous section) means that participants very understandably simply reported that they often defaulted to what they perceived as the expectations of their profession. The spiritually empathetic approach highlighted in the previous theme ‘nursing spiritually’ (4.3) was more difficult as it was seen as having no, or limited, empirical evidence particularly when the person presented with psychosis.

“There is no scientific proof if, if you’re a person that needs that then you’re not going to have any spirituality because there isn’t any proof of spirit as I’ve said before so how do you know it’s not a delusional belief? How do we know that all religion isn’t delusional?”

Kate

“When you hear people that have maybe been sexually abused as children and they’re hearing the voice of the dead person that abused them, who’s to say that the person still

isn’t torturing them? How can we say?” Rachael

Some of the participants expressed concerns that spiritual needs were not addressed because of ‘fear and anxiety’ that doing so might open up issues that were not able to be fixed or even exacerbate an existing problem:

“You could be opening a can of something that you don’t really know how to fix. Or it could feed into. I think they’re wary about feeding into something that could blow out of

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Harry

Other participants expressed ‘fear and anxiety’ around potential dangers of supporting a service user’s spiritual or religious expression. Chris described a situation where a service user had been very ill and isolated as a result. During her period of recovery she became a Jehovah’s Witness and regularly joined in church activities. As a result of being connected to this group she began to make a significant recovery in terms of her mental well-being. Chris welcomed this recovery but had reservations about how this could be maintained in the light of some of the teachings of that particular belief system and how mental health services could support her spiritual choice but encourage adherence to treatment. The following statement is from that part of the narrative and he talked about the positive social aspects of her new-found group of friends but he was clearly concerned about how the group’s spiritual and religious belief might impact on her recovery.

“She’s getting out and about with these other people so it’s not like she’s cutting her off and is just staying at home, she’s is getting social contact, in fact she is getting more but

if they persuaded her to stop having her medication then I might have to say it’s not such a good idea”

Chris

4.5 Chapter Summary

In this chapter, I have presented the findings from my study. I have presented the four main themes which I identified through analysis of the rich qualitative data obtained in the interviews with my participants. The themes I have discussed are: ‘Role of spirituality from personal perspective’; ‘Influences on professional understandings of spirituality’; ‘Nursing spiritually’; ‘Fear and Anxiety’. In the following chapter, I will summarise my findings and discuss how these relate to and further contribute to the existing literature in relation to mental health nurses’ understandings of and care for spiritual need.

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Chapter 5: Discussion

In the following chapter I discuss the findings of my study in relation to the literature. I have structured this in relation to the three top-level themes and the integrative theme identified from the data.