Régimen transitorio (problema hiperbólico)

This sub-theme addresses how spiritual care was approached using a team approach (an agreed way of working as a group of professionals) or team working (how an individual’s strengths were utilised to benefit a service user or users) in order to show what influenced professional understandings of spirituality.

Mental health nurses rarely work in isolation. Both within the hospital and community environment mental health nurses practice alongside one another and other mental health professionals, for example psychiatrists, social workers, occupational therapists,

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clinical psychologists and GP’s. The large number of professionals and associated agencies adds to the complexities of mental health care with implications for both service users and carers. In order to provide high standards of care it is essential to work effectively as a team. However, within those teams there is also a range of personalities each with their own perspectives and views based on their personal and professional experiences. This may affect how a team functions and may influence or alter an individual nurse’s preferred behaviour or approach within the team.

Some of the participants discussed their teams and the team’s ‘approach’ or ‘ethos’ and how working as part of a team influenced care. Ann described her team as cohesive and she made reference to a situation where a service user’s spiritual needs were at odds with a more traditional approach to care and discussed how the team she worked in tried to make the service users’ spiritual needs a priority and person-centred:

“There were discussions around, do we go along with statutory services and see where that gets us or do we just go for other type of care? But she is unique….. Unique. Quite a serious consideration has been given to that [that being her unique spiritual need] and

it’s not unusual in this team.”

Ann

She went on to discuss the team in positive terms of connectivity between the team members and their spiritual sensitivity and was asked if she felt that the spiritual sensitivity was unique to her within the team or whether they thought collectively. She responded:

“No, I don’t think it’s unique to me but then again, in terms of when you are working regularly with a group of people there’s sort of a spiritual connectedness within that isn’t

there? You get a vibe about what’s acceptable and what’s not and the different ways people work. They are very different practitioners but they all come up with the same thing and they are quite spiritually minded in terms of how they work with people. They

do it at different rates and in different ways but spirituality is always a consideration.” Ann

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If Ann’s statement is considered superficially the focus of her comment is about the positive cohesiveness of the team and how they work together for the benefit of the service user. However, her use of the word ‘acceptable’ in her statement suggested the integrative theme ‘fear and anxiety’ might need to be acknowledged at this point. The word itself suggested that it was common practice to have conversations and thoughts about spiritual needs of service users; they must fit in either explicitly or implicitly with the wider team approach. She stressed that as an individual within the team “you get a vibe about what is acceptable and you work within that”. What was not explicitly said, was what would happen to the individual nurse should they put forward a viewpoint that was against the ‘vibe’ or collective team ethos.

Ben and Lisa felt that different teams placed a different emphasis on the significance of spirituality however Lisa stressed the importance of the team working together. Freya again related back to her nurse training and said;

“I’ve watched nurses and not always agreed with the approach they’ve taken. For example they seem to become resilient to people’s problems and lack the empathy that

is required” Freya

However she intimated that even when this view or approach wasn’t shared by individual nurses they acquiesced to the team’s overall approach which might be inadequate and not support a service user’s spiritual need.

Harry said a good team was made up of individuals who took the same approach for consistency. This might be one of the reasons why individuals acquiesced to the wider team. He went on to say the cohesiveness of the team he worked with played to individual strengths within it. If a team member was not confident about dealing with spiritual matters they would ask for help and he offered an example which suggested he felt that it was a mark of respect to admit if there was an element of care which an individual nurse might find difficult.

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“An atheist person will acknowledge they’re not the best person to assist that person with their spiritual needs which is the good thing about our team because a lot of the things that I do that I’m not too sure about I bring back to the team [in meetings] and they would be respectful to that person’s spiritual need, this is my colleagues we’re talking about. There is no-one who would be disrespectful. They would say, I’m not the

best person to help you but someone else in the team maybe. That’s how our team works”

Harry

As he elaborated however it became apparent that his personal approach to care could be modified or changed based on the team’s influence.

“With our team as well it’s all very well me going in and saying one thing but we’ve got a team approach so I could go in one day and there could be another person going in another day who has got a completely different take on it, you know? Personal beliefs

and all that” Harry

Brendan identified certain secrecy in that some teams did not discuss spirituality at all and said:

“I do wonder about my work colleagues and their take on it, because we don’t actually talk about it in so many words. We talk about the technicalities [of mental health care]

and empathy and share experiences but not spirituality.”

Brendan

Mary, like Brendan said that the team she worked in never discussed spirituality. “I can’t ever really think about conversations that I’ve had with colleagues around

spirituality. Certainly about religion and certain cultural stuff, of course but actual spirituality, no I don’t think we ever have.”

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Chris considered individuals within teams and the difficulties individual personalities and perspectives bring when trying to address spiritual needs in service users.

“It’s difficult because every member of staff is different and some are more likely to think that sort of thing [spirituality] is more important than others so they might just say I’ll not

bother with that, because that’s what people do isn’t it?” Chris

In this section the integrative theme fear and anxiety was again identified. Rachael described the fear and anxiety of being ridiculed or judged by colleagues within her team should she disclose her inner thoughts around spirituality. She emphasised the change in her expressed views as a result of fear and anxiety about ridicule within her team by giving an example from practice. A service user had expressed what were viewed by the nursing team as delusional beliefs but she personally believed were spiritual phenomena.

“Can you imagine reading that out in your MDT meeting? They’d look at me and refer me to the NMC or get out the pink papers*” [*application for admission to hospital under

the Mental Health Act]. Because you’re scared that someone will think there is something wrong with you I think, that you believe that. They’ll think you’re not right in

the head” Rachael

She was asked if she had, had any conversations about her own spiritual beliefs with other members of her team and the integrative element ‘fear and anxiety’ is apparent in her response:

“No. [Why?] Because you worry that they might think there is something wrong with you. Do you know what I mean? They might think, oh bloody hell what’s she on about here?

So it’s a bit of a taboo I think. Yeah, you daren’t speak about it”

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Although Rachael was talking about her own experience and fear and anxiety she talked in the third person showing how uncomfortable she felt about expressing a taboo subject – it was as though she sought to distance herself from the concerns she was experiencing. This was not unique to Rachael – when participants became uncomfortable or felt the topic area was becoming a little too sensitive, many changed to using the ‘third person’ rather than ‘I’. For example, Isabel also switched to the third person and was visibly uncomfortable with a question around her own spiritual view and if she would be happy sharing it with the team. She said;

“I suppose some people might feel foolish, embarrassed in expressing what they find spiritual. I think it would depend on the individual. Some people aren’t forward with their

religious or spiritual ideas are they for fear and anxiety of people judging them. And yet it’s what we do as nurses… form a judgement”.

Isabel

I discuss this use of language further in section 4.4 (Fear and anxiety).

Freya was another participant who discussed an element of the theme ‘fear and anxiety’ in relation to worries of ridicule from her team and she covered up her personal anxiety with humour when she relayed a situation where she had experienced such ridicule within her team.

“Not everyone understands what I understand and when I’ve spoken about it I’ve been told I’m totally bonkers [laughed] so I keep my spirituality to myself and just be friends

with people. I’m nice to people”

Freya

This use of humour is similar to that exemplified by Harry earlier (see 4.2.2.2 and his references to ‘burning Pagans’) – and will similarly be further explored in section 4.4 (Fear and anxiety) later in this chapter.

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Overall this sub-theme has considered how a mental health nurse’s team’s collective thoughts affected care in relation to individual service users. Some of the participants talked about team decisions around spirituality and the openness with which the team discussed the service users’ needs to ensure that they were spiritually secure in some way. However, teams did not always afford the same respect to each other. This resulted in some participants being secretive about their own spiritual beliefs and needs which affected or changed how they approached care in service users.