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Nursing with Dignity

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VOL: 98, ISSUE: 09, PAGE NO: 33

Professor Paula McGee, PhD, MA, BA, RN, RNT, is nursing research fellow, University of Central England, Birmingham, and chair of the Transcultural Nursing and Healthcare Association

In 1989 Nursing Times ran a series of articles titled ‘Death with dignity’ which was such a success that a second series was commissioned in 1992. Both were then published as books.

We still get telephone calls from nurses who want a copy, so we decided to update the series and widen its brief to include all aspects of nursing care from the cradle to the grave. Over the past decade additional issues, such as abortion, organ donation and euthanasia, have created a minefield of ethical dilemmas.

Many nurses feel beleaguered as they struggle to provide excellent care. Bombarded with government edicts, mindful of clinical benchmarks on privacy and dignity, they often feel nervous about relating to their patients in an open and honest way. This is doubly ironic as that is precisely what many of the new policies are intended to achieve.

It is important that nurses, who represent many different ethnic groups and religions, are able to give their patients the best possible care. At the very least, this means having some understanding of a patient’s ethnicity, religion and culture.

Every religious need cannot be met in the NHS, overstretched and understaffed as it is, but there are times, particularly near or at the time of death, when a person’s religion, or lack of it, can become important.

We must remember that those who do not subscribe to any religion have a right to respect equal to those who hold religious beliefs. We also want to make it clear that we do not believe that any religion is more relevant than another.

When NT called for nurses to write the series a few months ago, we were overwhelmed by the response. The authors range from nursing students to lecturer-practitioners, and most have first-hand knowledge of the faiths they describe.

Within each religion and culture there is a wide spectrum of observance and belief. These articles are intended to act as a guide rather than a blueprint. We hope that this series will make it easier for nurses to relate to patients with tact and sensitivity.

Religious teachings give many people the values, attitudes and beliefs that underpin their lives. For devout believers this has a profound influence on their world view and how they should go about their daily lives, worship, eat, dress and relate to others.

The extent to which people adhere to the teachings of their religion varies. Devout believers follow the teachings closely, but even those who live more secular lives may return to their religion in times of crisis, such as illness or bereavement.

Nurses have a responsibility to ensure that patients’ religious beliefs are respected, especially when they lead patients to disagree with or reject medical or nursing interventions, and must recognise the anxieties of those who feel they cannot trust staff to care for them in an appropriate manner.

Such fears can discourage people from seeking help at an early stage, increasing their potential suffering and the cost of treating them later on.

Talking about respect for religion and showing it are two different things. Respect is bound up with notions of courtesy, liking and regard for others that are influenced by cultural values (Browne, 1993; Sugitherjah, 1994).

Respect is difficult to define but we all know when it is lacking. Showing respect for religion requires not just one set of actions but several.

Nurses need to learn about the different religious beliefs with which they may come into contact. This series describes the main beliefs and practices, but there are many variations in interpretation and practice.

Each faith has many different schools of thought. For example, Buddhism has several different schools, each of which emphasises different approaches to the teachings of Buddha.

Similarly, within Christianity there are many different churches, for example, Anglican, Catholic and Presbyterian, that take different approaches to the teachings of Jesus Christ.

Nurses must listen to what members of different religions have to say rather than relying on other professionals’ interpretations of beliefs.

Nurses must also think about the implications of religious beliefs for the profession. Showing respect is about being aware of the ways in which beliefs may affect the different elements of care.

The authors discuss food and fasting, preoperative shaving, treating objects of religious significance in a way that is consistent with the individual’s beliefs and ensuring privacy for religious ceremonies.

Adapting practice to incorporate such issues requires nurses to become more self-aware, and more conscious of their own values and how these may conflict with those of the patient.

Finally, it must be remembered that faith is an individual matter. Showing respect for beliefs is about recognising individual preferences.

- A Transcultural Nursing and Healthcare Association conference, titled ‘Culturally Competent Healthcare’, takes place on Tuesday, March 5, at the Commonwealth Institute, Kensington High Street, London. For the first time the association will be presenting awards for projects on developing culturally competent nursing care. Contact Julie Partridge, the Foundation of Nursing Studies, 32 Buckingham Palace Road, London SW1W 0RE. Tel: 020 7233 5750; e-mail: admin@fons.org

- This series has been endorsed by the Transcultural Nursing and Healthcare Association

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