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Joumal of Advanced Nursing, 1995,22, 808-815

'Spirituality as integrative energy':

a philosophical analysis as requisite precursor
to holistic nursing practice
Nancy C Goddard RN BScN
MN Candidate, University of Alberta, Edmonton, Staff Nurse, Post-Anaesthetic Recovery
Room, Red Deer Regional Hospital Centre and Staff Nurse, Home Core Deportment,
Red Deer Regional Health Unit, Red Deer, Alberta, Canada

Accepted for pubhcation 24 November 1994

GODDARD N c (1995) foumal of Advanced Nursing 22, 808-815

'Spintuahty as integrative energy': a philosophical analysis as requisite
precursor to holistic nursing practice
Spirituality is a universal human phenomenon, yet conceptual confusion,
ambiguity and scientific scepticism have prevented adequate investigation into
its potential healing effects A recent resurgence of interest in non-medical
sources of healing and holistic medical practices is causing increased
speculation regarding the nature of spirituality The lack of conceptual clarity,
and absence of a precise theoretical definition, prevent recognition of spiritual
distress and, hence, appropriate nursing intervention In this paper, current
usage and definitions of spirituality are discussed and a philosophical
definition of 'spirituality as integrative energy' is proposed The metaphysical
nature of this phenomenon makes it the proper concern of philosophy,
consequently, a philosophical analysis of the aforestated proposition was
completed using the five predicables of logic theory species, genus, differentia,
logical property and logical accident Implications of this definition for
providing holistic niirsmg care are also presented

TvTXij n n i rr-TTONT

gation into many existential and metaphysical phenomena

01 concem The pursuit ot nomothetic knowledge as the
The manner m which spirituality is conceptualized and primary legitimate goal of empirical science has resulted
defined will have significant lmphcabons for professional m mimmal research into those areas considered beyond
nursing practice and for the further development of a body the bounds of objectification and provability Conof nursing knowledge Most nursing theories espouse sequently, ldiographic knowledge has often been deemed
holistic ceire as a central disciplinary tenet, yet the human unscientific or anecdotal and is not highly valued for its
spiritual dimension is often neglected or mentioned only 'marginal' contribution to science
Westem society has, generally, tnpartitioned personEven amongst authors addressmg spintuality, concep- hood into distmct biophysical, psychological and spiritual
tual dispeinty is evident and results m vagueness and components and then banished the spiritual
ambiguity for the reader Additionally, the reification of dimension to relative obscurity while engaging m ongoing
logical-positivistic ideals, at the expense of philosophic and contentious debates surrounding mmd-body mterand naturalistic inquiry, has precluded adequate lnvesti- actions, individuals with a strongly logicalpositivistic
scientific philosophy tend to dismiss metaphysical conCorrespondence Nancy C Goddard Staff Nurse c/o Recovery Room, Red ^^^ms altogether and adhere to matenahstlC monism
Deer Regional Hospital Centre, 3942-50A Avenue Red Deer Alberta
predommant worldview (Bumard 1987) Proponen
Canada T4N4B7


dualism, or lmmatenEilism, acknowledge a metaphysical

1995 Blackwell Science Ltd

Spintuality as integrative energy

dimension but often consider only the psychological
realm, or consider the psychological and spintual dimensions to be overlapping or interchangeable
Humanistic paradigms tend to focus on tangible and
secular matenalism rather than on sacred or eschatological
concerns, such as death or the existence of an afterlife,
which fall withm the purview of spirituality The confusion precipitated by these mcompatible and antithetical
philosophies generates a dilemma for nursing as it strives
to increase its professional body of knowledge

Significance of spiritual dimension

If holistic care is the purported goal of nursing, then the
implicit nature of spintuahty must be explicated since the
'nurse's acknowledgement, appreciation, and respect for
the spintual meanmg m a person's life (regardless of
how unusual the person's behef is) can be comforting
to the person' (Watson 1985) Recently there has been a
resurgence of interest in non-medical sources of healing,
as adjuncts or alternatives to allopathic medicine, and an
increased emphasis on treatment of the whole individual
These methods must be explored to determine their efficacy and safety before being readily assimilated mto practice, however, they may provide effective and efficient
means of increasing overall general health and enhancing
coping skills
Although the significance of the spiritual dimension is
verbally acknowledged in the nursing domain, it is often
pragmatically circumvented in the realities of clinical
practice for a variety of reasons, not the least of which
may include differences in underlying patient and nurse
philosophical positions Nurses may feel inadequately
prepared to address spiritual needs or may be embarrassed to discuss a subject which is often considered to
be highly personal or pseudoscienbfic The inability to
distinguish clearly between the psychological and spiritual dimensions, as well as the oft referred to identification, or interchange, of spirituality and religiosity,
potentially results in the neglect of, or inability to meet,
patients' spiritual needs The separation of physical,
psychological and spiritual dimensions is also antithetical to a holistic approach smce the central tenet of holism
IS unity and the premise that the whole is greater than
the sum of its parts
Conceptual clanfication is imperative if these difficulties
are to be overcome, therefore, the purpose of this paper is
to examine contemporary usage and definitions of spirituality and to suggest an altemative, philosophical definition
which might dispel some of the myths surroundmg spintuahty and eliminate some of the current impediments to
hohstic practice CoroUanes of goal attainment would
include increased comprehension and ease of mtercoUegial and interprofessional commumcation, an anticipated concomitant nse of mterest m metaphysical

phenomena, and an emphasis on alternative research

Spintuahty is a universal human dimension which inheres
every individual, whether religious, humanist, hedonist or
atheist (Broccolo 1990, Carson 1989, StoU 1989, Van Kaam
1976), It may, however, be denied or remain underdeveloped or dormant (Pierce & Hutton 1992, Carson 1989,
Watson 1988) The human spint is the core, or essential
part, of the person (Broccolo 1990, Piles 1990, Swinburne
1986, Van Kaam 1976) which acts as a creative force to
precipitate change and integrate all of the dimensions
(Mansen 1993, Haase et al 1992, Heliker 1992, Reed 1991,
Byme 1985, Frankl 1984, Van Kaam 1976) It is the
d}mamic force that keeps a person growing and changing,
continuously mvolved in a process of emerging, becoming
and transcendmg of self, it is through this gestalt pro(ss
that life IS mibued with meaning and a sense of purpose
for existence (Van Kaam 1976)
Spiritual activity may be related to existential or to metaphysical subjects and involves introspection, reflection
and, often, a sense of connectedness to others or the universe Metaphysical spirituality is generally centred on
God, or a deity, while existential spirituality focuses on
humanistic values, behefs or principles which guide and
direct one's hfe (Mickley et al 1992, Kams 1991, Amold
1989) Spirituality, then, encompasses all aspects of bemg.
It IS a way of experiencing hfe, individuals, and one's
phenomenal environment (Moore 1992, Wald & Bailey
1990) Moore (1992) suggests it 'has to do with depth,
value, relatedness, heart, and personal substance' and is
not 'an object of religious behef or [as] something to do
with immortality' Spirituality is an approach to hfe,
which IS made manifest m ordinary, or in extraordinary,
circumstances, it is a pervasive force operating through
commonplace, or quotidian, events Various authors have
stressed that spintual growth occurs as a result of, and is
expressed through, the mundane activities of daily hfe,
such as poetry, music, art, stories, social relationships and
altmism (Moore 1992, Hutchings 1991, Mealey etal 1989,
Frankl 1984)

Frequently, throughout the hterature, spirituality is mistakenly interchanged or used synonymously with religiosity, or such psychological vanables as hope, peace,
worth, inner being and well-being Spintuahty and religiosity have been poorly differentiated in the past and it is
only recently that these terms have acquired greater specificity (Kreidler, cited m Emblen 1992, Hanmer 1990)
Religion exemplifies a particular value and belief system

1995 Blackwell Science Ltd, Joumal of Advanced Nursing, 22, 808-815


NC Goddard
and provides an ethical-moral code, or framework, for
behaviour (Mickley et al 1992, Carson 1989), it refiects
contemporary cultural values, personal philosophies, and
IS socially constructed (Widerquist 1991, Brooke 1987,
Bumard 1987) Religion is organized, mstitubonalized,
and serves as merely one of many possible means of spiritual expression (Emblen 1992, Allport 1961)
Msiny nursing cumcula present students with an overview of particular religious doctnnes, pracbces and dietary
restrictions common to a vanety of cultures, this leads
students to assume that attenbon to a patient's religious
rituals and requirements will satisfy spintual needs
(Mansen 1993, Creen 1992, Hutchmgs 1991, Byme 1985)
Educational preparation with a greater emphasis on recognition and assessment of spintual integrity, as disbnct
from religious association, would facilitate or enhance the
provision of holisbc care (Fish & Shelly 1978)
Although the spiritucd and psychological dimensions
have been theorebcally delineated, there remains a considerable overlap m behavioural expression, this leads to
confusion and hermeneutic ambiguity Since the metaphysical nature of this phenomenon precludes direct
observation, its presence and state of integrity must be
inferred from overt behaviours or discermble moods and
emotions (Arnold 1989, Labun 1988, Brooke 1987,
Cbapman 1986), therefore, assessment of atbtudes and
bebaviours may suggest subtle clues to both dimensions,
and interpretation requires caution and sensitivity The
inability to distinguish clearly between the spiritual and
psychosociai dimensions presents a formidable challenge
to the nursing profession, careful examination reveals that
psychosocial concepts are not interchangeable witb spiritualify and tbe failure to differentiate amongst these
terms contributes to neglect, or denial, of spiritual

out of disharmony, it is mdispensable m nursmg care' She

also contends that the spmt controls the mind and therefore, indirectly, the body The spirit, therefore, must be
considered the pnmary locus of healmg, with the associated abilify to influence general health
Finally, a lack of personsil spiritual awareness on the
part of the nurse may lead to avoidance of, or failure to
identify, spintual distress or needs m others (Widerquist
1991, Arnold 1989, Bumard 1987, Carson et al 1986) Selfknowledge and the recognition of one's personal philosophical perspecbve are considered essential prerequisites
to development of sufficient sensitivity to appreciate the
complexity and potential consequences of acknowledging
this dimension
A review of current usage illustrates the lack of a comprehensive definition which would provide conceptual
clanfy and facilitate lntraprofessional understanding and
tbe abilify to recognize spiritual integrify or distress The
highly abstract nature of spintuality, its frequent synonymous mtercbange with religiosify, the difficulty m articulating differences between psychosocial and spiritual
domains, and the dismissal or denial of metaphysical concems by some, all contribute to conceptual confusion and
lnabihfy to define this phenomenon adequately Without
a precise theoretical definition of spirituality it will remain
difficult to recognize, or to appreciate, spintual meaning
and/or distress, mucb less than to meet spiritual needs m
professional nursing practice
Universal qualities

It IS the contenbon of this writer that, despite sociocultural

and individual vanabons in spiritual acknowledgment
and expression, there are underlying essential qualibes to
the spiritual dimension which Eire universal m nature and
which must be explicated to ensure truly holistic nursing
care To search for essences is to search for commonalities,
Conceptual consensus
or universals, which transcend individual experiences of
Conceptual consensus regarding spirituality cannot be the phenomenon of inquiry and are recognized as central
achieved without agreement on its essenbal consbtubve features of tbe construct
elements and subsequent specification of empirical referImplicit m the aforenoted contemporary definitions is
ents, these could then be employed m the formulation the idea that spmtualify pervades, unites and directs all
of a precise operational defimbon which isomorphically human dimensions and, tberefore, consbtutes the intemal
represents its theoretical definition Unbl this is locus of natural health Consequently, a definition of spiriaccomplisbed, from a scientific perspecbve, tbe objectifi- tuality as integrative energy is hereby proposed Since
cation of spirituality will remain an elusive ideal spmtualify IS a metaphysical concept, it is the proper conConfusion surrounding the nature of spirituality may act cem of philosophy Hence, a philosophical analysis is
as a deterrent to many nurses who would otherwise appropriate and was undertaken to evaluate the suitabilify
address this phenomenon It could also provide a source of this defimtion for providing conceptual elanfieabon and
of discomfort, or embarrassment, to many m a discipline for building a foundabon for holisbc care
that values, pnmsirily, scienbfic pnnciples (Piles 1990,
Chapman 1986)
Neuman (1989) states that spiritualify may be 'elusive,
inexplicable, or merely philosophical, but because it cre- A philosophic analysis involves the examination of a conates order out of cbaos, sense out of madness, or barmony cept or phenomenon form an ontological perspective, it

1995 Blackwell Science Ltd, Joumal of Advanced Nursing, 22, 808-815

Spintuality as mte^ative energy

uses the five predictables of logic theory to evaluate the
truth or falsity of a proposition A proposition is simply a
statement which affirms or denies something, it is a categoncal statement which is formed of a suhject, copula and
predicate (Bachhuber 1957) The copula is 'is' or 'is not'
and determines whether the proposition is affirmative or
negative, it is used to bring together, jom or 'copulate' the
subject and predicate 'Spirituality is integrative energy' is
an example of an affirmative proposition
The five predicables, denved from Aristotelian logic and
later reformulated by Porphyry, are a classificaUon of universals which express the essence, nature, or quiddity,
of subjects in a logical proposition of which they are
predicated (Runes 1983, Bachhuber 1957) They include
species, genus, differentia, proprium and accidens
Species, genus and difi^erentia (or specific difference) are
essential predicables smce they express all, or some, of
the constitutive elements of the subject's quiddity, or
nature Logical property (proprium) and logical accident
(accidens) are non-essential predicables because they do
not express natural elements but refer to necessary or
contingent attributes
A clear imderstandmg of the nature of spirituality is
imperative for the development of a real and universal
definition Therefore, this process will be used to evaluate
the truth of the declarative proposition 'spintuality is integrative energy' which has been proposed as a definition of

cal or mechanical energy The genus 'energy' expresses the

common quiddity, or nature, which spirituality shares
with the aforenoted similar species
The 'differentia', or specific difference, is a defimng
eharaetensbe which differentiates one species of a genus
from another, it connotes that which must be added to the
genus to develop a species (Mill 1974, Stebbmg 1961)
'Integrative' is the differentia which distinguishes 'mtegrative energy' (the species) from other species within its
proximate genus 'energy', such as electncal, chemical or
mechanical energy
The reciprocal relations between species, genus and
differentia form the basis of real, as opposed to nominative
definitions, a discussion of which follows The species
(integrative energy) is revealed by the combmation of
genus and differentia and expresses the complete essence
of the subject (spirituality), it is convertible with the subject The genus (energy) is the broad class of subjects which
share an essence with two or more subclasses, it mcompletely expresses the subject's (spirituality) nature The
differentia (mtegrative) distinguishes one species (integrative energy) from other species within the genus by adding
a constitutive note, or defining characteristic
Non-essential predicables

'Proprium' (logical property) and 'accidens' (logical accident) refer to attnbutes which necessanly or contingently
accompany the essence but are not part of the essence A
logical property, or proprium, is a universal that signifies
Essential predicables
an attnbute which, although not part of its quiddity, is
A 'species' expresses the completely determined essence necessanly and conceptually inseparable from its subject
of a subject and answers the question 'What is the thing (Mill 1974, Dewey 1938) The subject, therefore, cannot
(subject) essentially''' (Bachhuber 1957) It is the 'what- be conceived of sans property without contradiction
ness' of the concept Specific distinguishing attnbutes Bachhuber (1957) descnbes two types of logical properties,
which differentiate this subject from others of similar specific and genenc, both of which are necessarily connecessence are not, however, identified In the affirmative ted to the essence of the subject
A 'logical specific property' refers to an attnbute that
proposition 'spirituality is integrative energy', the species
IS 'mtegrative energy' which describes the quiddity, or results from the completely determined essence of a subessential nature, of spintuality Although there may be ject, or the species (combined genus and differentia) It is,
vanous types of mtegrative energy, the species simply therefore, demonstrable in every member of a species and
descnbes the essential, rather than the attributive, charac- IS particular only m such members A logical specific propteristics which must be present in order for mtegrative erty of spirituality would be 'capable of producing intemal
human harmony, or holism' This property necessanly
energy to be considered spintuality
Species IS a relatively narrow subdivision of a wider anses from the completely determined essence of the
class, or genus, which has been individualized by some species 'spirituality', it anses from a combination of the
specific difference The 'genus' is that portion of essence genus 'energy' and the differentia 'mtegrative' To meet this
which IS shared by other individual subclasses or species, cntenon, it must also be common to all instances of spintuit IS a umversal that expresses the mcompletely deter- ality and peculiar to spirituedity To consider spintuality
mined nature of a subject and provides only a partial without this extant property, in any culture, religion or
answer to the question 'What is a thing essentially''' (Mill individual, would result m conceptual contradiction,
1974, Bachhuber 1957) 'Energy' is the genus of 'spintu- consequently, it is a logical necessity which fiows from the
ality', and that which can be affiirmed of energy, such as subject It IS adherent to the essence of all forms of spintuits available power, activity or force, can also be affirmed ality but IS not a charactenstic of its quiddity This property
of all its vanous forms, including physical, mental, electri- does not anse solely from the genus 'energy' smce other
1995 Blackwell Science Ltd, Joumal of Advanced Nursing, 22, 808-815


NC Goddard
forms of energy do not necessanly mtegrate or umfy, but Table 1 Synoptic schema spintuality and the predicables*
from the species itself Therefore, to be capable of achievmg
The predicables
intemal human harmony is a necessary attnbute of all The quesUon
forms of spintuality and is particular to spmtualify
A 'logical genenc properfy' refers to an attnbute that 1 What IS spintuality Integrative energy
results from the incompletely determmed nature of the
To what immediately Energy
subject It anses from the shared consbtuent elements 2
more general class
common to all species within a broader class, or genus
of things does
Logical genenc properties wbich are attnbutable to spmtuspintuality belong'
ality, inasmuch as spmtualify is an energy, include incor- 3 What kind of energy Integrative
poreal, vital, potential, vigorous or forceful Each of these
IS spintuality'
attnbutes is shared by spintuality and by all other species
What IS the basic
of the genus 'energy', in other words, they arise from the
note, or
genenc nature of energy
characteristic, that
A 'logical accident', or accidens, is an attribute wbich
spirituality from
has no conceptual connection with the subject's essence.
other energies'
It bears a purely contingent relationship to the subject of
4 What are some
Capable of
Logical specific
which it IS predicated (Dewey 1938) Although a logical
attnhutes that
producing mtemal
accident is compatible with the subject, its removal would
spirituality has
human harmony, or
not contradict conception of the species (Mill 1974,
specifically because holism, by
Bachbuber 1957) Transcendence and relabonal connecIt IS spintuality'
combmmg body.
tedness to others are logical accidents m relabon to the
mind and spint
essence of integrative energy The capacity for spmtualify
What are some
Logical genenc
to be metaphysically or existentially transcendent exists,
attributes that
potential, vital.
spirituality has that vigorous, forceful.
yet It can also be tbought of, without contradiction,
it shares vi^th other transforming.
without either of these particular attnbutes
A summary of the five predicables m relation to spmtu5 What are some
Logical accident
ahty IS presented m Table 1 as a synopbc schema which
attnbutes that are
has been adapted from that developed by Bachhuber
compatible vnth the
(1957) An examination ofthe S3Tioptic table and refiection
essence of
upon the philosophic analysis supports acceptance of the
spirituality but do
affirmative proposition 'spirituality is mtegrabve energy'
not necessarily
as a defimbon of spmtualify
accompany it'
* Table format adapted from Bachhuber A (1957) Introduction to
Logic Appleton-Century-Crofts, New York, p 251


Before proceeding, it is important to note that there are
two types of definitions, nominal definibons and real
definibons A nominal defimbon simply subsbtutes a synonym, a description, or an example for the unknown term
and IS not used to reveal the nature, or quiddify, signified
by the term
Concepts, such as spintuality, are universal nobons
which are abstracted forms presented to the mmd separate
from embodied matter, they express that which makes
a subject what it is (Stehbmg 1961, Bachhuber 1957)
Therefore, a comprehensive, or real, defimbon circumscnbes tbe limits of a concept by descnbmg the properbes
which form its essential nature It declares the essence of
the subject and is always a complex term with a minimum
of two parts, one part descnbes what the subject bas m
common with similcir kinds of thmgs, and the other, what
differenbates the suhject from similar kinds of things
(Bachhuber 1957)

Tradibonally, a defimbon is based upon, and communicated by, tbe tbeory of tbe predicables, in parbcular, genus
ind differentia, which are logical distmcbons rather than
ontological disbncbons, like species and genus (Stebbmg
1961, Dewey 1938) An essenbal definibon is compnsed
of genus and differenba, it expresses the completely
detemuned quiddify of its subject and is a proposibon of
equivalence, or convertibilify
A clear, precise theorebcal definibon which is universal
and acceptable to the majonfy of nursmg pracbboners will
have significant consequences for clinical pracbce A good
defimbon requires clanfy, brevify, coextension with the
subjecbve term, and must be posibve, whenever possible
(Bachbuber 1957), it avoids tautological and metaphoncal
language for the sake of ontological precision Coextension
implies that the defimbon is applicable to all members of
a species and only to those memhers, it distmgmshes the
subject from all other subjects and is perfectly converbble

1995 Blackwell Science Ltd, Joumal of Advanced Nursmg, 22, 808-815

Spintuality as inte^ative energy

Some terms can only he defined negatively, for example,
spintuality must be considered as incorporeal or immatenal smce it lacks matter and form Nevertheless, 'the
ideally perfect definition is not supposed to give us the
fullest possible knowledge ofthe thmg defined hut merely
to state Its essence' (Bachhuber 1957) The attrihutive
proposition 'spintuality is integrative energy' constitutes
a real defimtion, it affirms something about spintuality
and IS convertible insofar as spintuahty and integrative
energy are equivalent and synonymous hi other words,
the suhject and predicate are lsomorphic
Conceptual clarification and a universally embraced theoretical definition are two requisite precursors to holistic
care An examination of, and reflection upon, the predicables will illustrate numerous potential consequences of
achieving this goal

Differentia 'integrative'
hitegrabon is the process of bringing together mcorporate
parts mto an mtegral, hannomous whole In human terms.
It IS the process of umfymg the biophysical, psychosocial
and spintual dimensions to create an internal harmony
which can he demonstrated through affect and emobons
as peacefulness, contentment or tranquility O'Bnen (cited
m Lahun 1988) descnbes altered spiritual integnty as
exj>enences of spiritual pam, alienation, anxiety, guilt,
anger, loss and despair Overt behaviour or expression of
feelmgs which refiect these descnptors should alert nurses
to the need for interventions aimed at restoration of spmtual mt^^ity, such as values clanfication, empathetic
inquiry and attenbve, silent listening
Logical specific property 'capable of producmg
intemal human harmony, or holism'
Capacity in this instance describes a latent potential for
activity. It can be thought of as a resource which the mdividual can draw upon m periods of personal cnsis to mamtam or restore a sense of stability in life Cntical life events
(such as threatened health or well-bemg) or relabonships
are frequently the precipitabng antecedents of spintual
distress Recogmbon of distressmg extraquobdian situations, or spiritual turmoil, will lead the nurse to intervene
and explore areas of existenbal, metaphysical or eschatological concem with his/her patients Empathetic listening, caring, physical presence and discussion may assist
the patient to focus on the situabon and facilitate the
ascripbon of meanmg to personal suffenng or unpalatable events

Species 'integrative energy'

A designation of spirituality as energy capable of producmg intemal harmony of body, mmd and spint emphasizes
a holistic approach and should dispel any religious overtones or misassociations Although some nurses may deny
a metaphysical reality, it is probable that most have experienced, on occasion, dramatic or devastating life-altenng
events which have resulted m a need for intemal dimensional reunification or restoration of harmony, therefore,
conceptualizing spirituality in nonparttsan and nonreligious terms should permit greater empathy with
patients and also emphasize its universality For nurses Logical generic properties 'incorporeal, vigorous,
with a poorly developed or absent sense of personal potential, vital, forceful, transformational power'
spintuality, it could potentially lead to increased self- These are attributes that spintuality shares with edl other
awareness or at least a respect for the spirituality of others forms of energy Conceptualizabon of spirituality as an
as distinct from religious expression
energy form implies acceptance of its extant properbes, as
specified Energy which can be focused internally fortifies
and strengthens positive thinking and can be used
Genus 'energy'
Energy implies activity, or the potential for activity, conse- creabvely to achieve harmony and mobilize or enhance
quently, in order to provide holistic care, nurses may be mtemal defences, therehy facilitatmg well-bemg and inner
required to act as catalytic forces in the transformabon of healmg Harpur (1994) has stated that
potential eneigy mto kinebc energy Energy sbmulabon
If the non-medical healer, religious or secular, can manage to trigcan be accomplished through the development of a trustger the mechanisms ofthe healee's mind to produce (or strengthen
ing relabonship and attenbve listening, this will help the
the production of) whatever resources are availahle to the body
patient to focus on his/her inner self, to consider and clarto comhat the illness or malady in question, is this any less welify issues or cntical life events, and may precipitate the
come or marvellous than results produced by conventional mediattribubon of meaning to situabons or events, thereby leadcal interventions'? The bottom line in both cases is the health and
mg to mtegrabon and intemal harmony Bemg present
comfort of the patient
with an empathebc and carmg disposibon may be the only
requisite nursing activity needed to provide the catalyst
for this manipulation of energy into a powerful kinebc
healing force

1995 Blackwell Science Ltd, foumal of Advanced Nursing, 22, 80a-815


NC Goddard
Logical accidents 'transcendent, relational'
These attnbutes are compabble with the essenbal nature
of spmtualify but do not necessanly accompany it A metaphysical or an existenbal transcendence may occur as a
function of spmtual mtegrabon or expenence but its
absence in no way dimimshes the conceptualizabon of
spmtuahfy Similarly, spmbiahfy is often manifested m
relationships to God, a diefy, or other mdividuals, it can,
however, be present solely within an individual and
removal of this relabonal attnbute does not contradict conceptualizabon of the essence of spmtualify as mtegrabve
From a philosophical perspecbve, the interest and concem regarding metaphysical and eschatological issues
make this concept relevant to nursing by virtue of tbe
ascripbon of meemmg and purpose to human existence
The premise that a person's spmt is the locus of healing
requires further mvesbgabon because of its potenbal
strength and abilify to influence health status and outcomes directly through the mobilization and focusing of
intemal energy Exploration of tbe human spmtual dimension demands an approach that is fiexible, holistic and
open to metaphysical ideology A re-evaluabon of the
spintual dimension will require that methods of naturalistic inquiry be employed to increase understanding of this
phenomenon Since phenomenological research has its
epistemological origins m philosophy and searches for
commonalities, or essences, which transcend individual
expenences, it is particularly appropriate to inquiry into
spmtual dimensionalify

Nursing cumcula
Integration of spirituality into nursing cumcula and recognibon of its transcendent, universal nature will prepare
pracbtioners to recognize spmtual distress and plan for
appropnate intervention It would also facilitate mtraprofessional imderstandmg and communication
Conceptual elanfieabon and the formulabon of an accurate and acceptable theorebcal definibon of spirituality are
the mibal steps to achievmg nursing's goal m terms of
holistic nursing practice Spmtualify as mtegrabve energy
has been proposed as an essential defimbon and, if
adopted, will be mstmmental m planning intervenbons
directed towards meebng pabents' spmtual needs, ensuring holistic care, emd adding to the further development
of a body of professional nursing knowledge

Allport G (1961) The Individual and His Religion Macmillan,
New York
Arnold E (1989) Bumout as a spintual issue rediscovenng meaning in nursing practice In Spintual Dimensions of Nursing

Practice (Carson VB ed), WB Saunders, Philadelphia,

pp 320-353
Bachhuber A H (1957) Introduction to Logic Appleton-CenturyCrofts, New York
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