In a nutshell . . . .

In the following illustration, you'll see that this principle is the second of the three principles that together make up the mindset of Careful Nursing. You'll read about how Careful Nursing recognises the presence of the human spirit and human spirituality in nursing. 

Since ancient times, images and symbols of nursing have been consistently associated with spirituality. The roots of Careful Nursing follow from this long historical association 

You'll read about how Careful Nursing recognises the presence of the human spirit and human spirituality in nursing. Since ancient times, images and symbols of nursing have been consistently associated with spirituality. The roots of Careful Nursing follow from this long historical association.

It is explained that in Careful Nursing, Infinite Transcendent Reality is the name given to the source of spirituality – such that awareness of this spiritual source is open to nurses of all backgrounds.

The name itself describes what it is. It is infinite. We are finite beings so we don't have the ability to directly know an infinite being. It is transcendent, that is, it exists beyond the normal range of human experience. It is, nonetheless, a reality in human life processes. It is often experienced as beauty or a sense of wonder, or in a search for meaning in life. It is a mystery experienced in all cultures.

You'll find that spirituality in Careful Nursing doesn't centre directly on meeting patients' spiritual needs. Rather, spirituality is an inner quality of mind and spirit which we nurses, in ourselves, bring to our practice. Our inner spiritual quality wells up in and shines through our attitudes and actions, for example, our calmness, patience, attentiveness, kindness and compassion, even under the most stressful circumstances.

Our spirituality is the central healing element in our nurse-patient relationships, in our relationships with one another, and in our relationships with all whom we encounter in our practice. 

Very importantly, you'll find it emphasised that to establish and support our awareness of our inner spiritual being it is essential that we practice "stillness", any form of meditation, for at least 5 minutes during our own personal time every day.

"Stillness" is a "must do" for Careful Nursing practice.

This second Careful Nursing principle, Infinite Transcendent Reality in life processes, concerns an infinite, most perfect pure spiritual being, which is the source or 'first mover' of all created things (Aquinas 1265-1274/2007, I, Q 2, Art 3),* and from which human persons receive their being and spirituality.

This principle elaborates this spiritual source of life as it concerns human persons and their spiritual being. This principle explains why human spirituality is fundamental in Careful Nursing and what this means for nursing practice.

Meaning of Infinite Transcendent Reality

The meaning of Infinite Transcendent Reality is evident in its name. This most perfect pure spiritual being is infinite, existing everywhere and beyond time. Because we as human persons are finite beings, we do not have the capacity to know directly a being who is infinite. This being is transcendent, meaning that it is beyond the normal range of our experience of our material universe. At the same time this being is a reality in the human life process. Although this reality is a mystery to us, we have the ability to apprehend and to know indirectly this spiritual being, an ability which is acknowledged in all cultures (Spitzer 2015).

In drawing on the philosophy of Aquinas, understanding of Infinite Transcendent Reality in Careful Nursing follows the Christian intellectual tradition. The Careful Nursing elaboration of this tradition is broadened in an encompassing way in order to reach out to all understandings of the spiritual in human life.

In beginning his examinaton of this most perfect pure spiritual being, Aquinas builds on on Aristotle's principle that, based on human experience of existence, movement and change in the universe, there must be a distant, 'unmoved mover', a source of all that exists, moves and changes.

Aquinas argues that Aristotle's 'unmoved mover' is in fact a 'first mover', a most perfect pure spiritual being who creates and sustains all things in the universe, especially and most perfectly human persons. Because this spiritual being is infinite, Aquinas argues indirectly for the existence of this being based on what it is not, and from natural effects it causes which are evident to human persons through their senses (Aquinas 1265-1274/2007, I, Q 2-26), for example, the abundent beauty so evident in nature. 

In creating and sustaining the being of human persons this most perfect pure spiritual being is intimately present to them in participatory relationship and in fostering their participatory relationship with one another. Aquinas elaborates also on Aristotle's idea that goodness is what all things desire; that all are innately drawn to seeking what is perfect and good, particularly their own goodness and perfection in relation to this most perfect pure spiritual being.

Aquinas (1265-1274/2007) accepts on faith the nature of this pure spiritual being is love and he uses reason to examine what this means (I, Q 20). He argues that the love of this most pure spiritual being for everything, especially for all human persons, is the primary expression of its will for the good in every person. In participatory relationship with human persons this pure spiritual being infuses all abundantly with boundless love and goodness which draw all persons to it. In responding to it with free will, human persons grow in love and goodness which predisposes them to act with love and goodness toward themselves and one another (I, Q 19-21; 23-25). An article outlining the thinking of Aquinas and Aristotle in more depth can be found here

As mentioned above, the name Infinite Transcendent Reality is understood and used in Careful Nursing as an encompassing term for the source of spirituality in life processes. Other ways in which nurses may conceptualise spirituality are considered broadly similar to the meaning of Infinite Transcendent Reality, for example, as it is conceptualised within particular spiritual systems of thought and belief for which different cultures and groups have different names. 

Experience of Infinite Transcendent Reality

Existence of Infinite Transcendent Reality is also evident in human experience; that is, awareness of this Reality may arise from experience of it as "That which is there" (Blackburn 2016, p. 265). Different persons may experience this Reality in different ways and on different levels. The encompassing name, Infinite Transcendent Reality, allows for its broad understanding by as many nurses as possible. 

For example, Infinite Transcendent Reality may be experienced as a sense of wonder or beauty. Although we are finite beings, we can have intimations of something infinite and transcendent, such as, when 'touched' by the sounds of beautiful music or the perception of beauty in nature; perhaps a flower, a flowing stream, or clouds against the sky. Poetry can also open for us a sense of wonder, for example, in Wordsworth's Ode Intimations to Immortality (2004).

Such wonder is also sought, often longingly, in the human desire to find meaning and purpose in life.The process of personal growth in our life process, even though it may involve difficulties and anguish, can also open up experiences of personal transformation, for example, as reflected in Hans Christian Anderson's tale of The Ugly Duckling (1843/2013) http://www.andersen.sdu.dk/vaerk/hersholt/TheUglyDuckling_e.html

Most human persons have a desire to search for and to know Infinite Transcendent Reality in their life (Spitzer 2015). While some may say that they do not experience, or seek to experience, a spiritual reality at all, from a Careful Nursing point of view they have the potential to experience this reality. Some may reject the existence of Infinite Transcendent Reality in life processes or understand the experience of transcendence as a psycho-social phenomenon alone. At the same time, in Careful Nursing all nurses are considered as persons and all human persons have spiritual being however they may experience or understand it.

Background of the spiritual in nursing

Since ancient times, images and symbols of nursing have been consistently associated with spirituality (Connell 1983, Meehan 2012). Since the 1^st century AD nurses have cared for poor, sick, injured and vulnerable people within a spiritual context. Following the 17^th century Enlightenment and with the rise of modern science in the 19^th century, spirituality in nursing became invisible. However, since the 1970s much effort has been made to make spirituality visible again in nursing. There is now an extensive literature on the spiritual in nursing and a range of views on the role that it should have in nursing practice (Timmins & McSherry 2012). You can read more about the history of the spiritual in nursing here

It is recognised that not all nurses accept the historical evidence that nursing is associated with spirituality in life processes. Or nurses may think of spirituality as a psycho-social phenomenon. In this case human characteristics commonly associated with the spiritual aspect of human life, such as, generosity of spirit, kindness and compassion can be thought of as professional values which motivate nurses' practice. However, the advantage of drawing on spirituality as the foundation for these characteristics is that it is understood to predispose human persons particularly to their expression in human relationships. An article on the range of different understandings of spirituality in nursing can be found here

The spiritual in nursing practice

The literature on the spiritual in nursing practice focuses mainly on nurses' attention to patients' spiritual needs. In Careful Nursing patients' spiritual needs are included in assessment and addressed as necessary, particularly as patients may wish to be visited by a member of a hospital's chaplaincy department. In Careful Nursing, nurses' main spiritual focus is placed on their awareness of their own spirituality, on how it can strengthen them in themselves and enhance their practice.

In relation to spirituality in practice, nurses focus on themselves as human persons in terms of the philosophical principle of the nature and inherent dignity of the human person, as discussed in the previous webpage. In Careful Nursing, spirituality relates to how we are in ourselves as human persons; on how we practice nursing as human persons. 

It is the contemplative aspect of our inward life of mind and spirit that relates to the spiritual in nursing practice. Our inward life enhances the special qualities of our relationships with patients, qualities such as calmness, patience, attentiveness, generosity of spirit, kindness and compassion. While we necessarily and importantly have a high level of awareness of our outward life and focus on the bio-physical reality of body and senses, we sometimes have only a minimal level of awareness of our inward, contemplative self and the role of our inward life in our practice. It is important that we enhance our awareness of our inward life so that we can bring awareness of both the inward and outward aspects of our life into balance in our practice. The importance of this aim will become evident when we come to the practice model.

We can work towards enhancing awareness of our inward life by spending a short time each day, at least five minutes, in stillness. In Careful Nursing, stillness is defined as a process of relaxing the outward life of the body and senses and becoming increasingly aware of the unitary, inward life of the spirit. Stillness is a relaxation and meditative process which is done sitting in a chair and which uses the natural flow of the breath to foster relaxation and enhance awareness of the inward life of the spirit. It can be thought of in different ways according to which way best suits individual nurses, as suggested in the following Figure: 

 Practicing stillness for at least five minutes each day is a 'must do' for the practice of Careful Nursing. This practice makes it possible for us to develop the habit over time of being truly still and 'listening' to our inward life. It allows us the space to explore our inward life and develop awareness of our spiritual being. It supports our self-care. And, it strengthens our capacity to truly engage in therapeutic nurse-patient relationships.

The aim of practicing stillness each day is to develop the habit of calmness in our professional life; to develop our natural capacity to be calm. Some of us are naturally calmer than others, but we all begin this practice from where we are in ourselves and proceed from there. We all have the capacity to become more calm in ourselves.

It is really important for our practice of Careful Nursing that we attend to our inward life of mind and spirit. The practice of stillness will help us gain insight into how our spiritual being infuses our practice in a way that disposes us to act calmly and with kindness and to think clearly. In turn, these qualities strengthen us in ourselves as unitary human persons and enhance our natural ability to protect the people we care for from harm and foster their healing and health, or sometimes their peaceful end of life. In the professional practice model the fundamental importance of the practice of stillness as a basis for developing an inherent sense of calmness will become markedly evident.

* The standard method of referencing specific sections of Aquinas's Summa Theologica is according to Parts (P), Questions (Q), and Articles (Art).

References

Anderson HC (1843/2013). The Ugly Duckling. The Hans Christian Andersen Center, University of Southern Denmark. Retrieved from http://www.andersen.sdu.dk/vaerk/hersholt/TheUglyDuckling_e.html

Aquinas T (1265-1274/2007) Summa Theologiae. Cambridge University Press, Cambridge.

Blackburn S (2016) Reality, The Oxford Dictionary of Philosophy, Online version (2^nd rev. ed.), Oxford University Press, Oxford, p. 265.

Connell M-T (1983) Feminine consciousness and the nature of nursing practice: a historical perspective. Topics in Clinical Nursing 5 (3), 1–10.

Meehan TC (2012) Spirituality and spiritual care from a Careful Nursing perspective. Journal of Nursing Management, 8, 990-1001.

Spitzer R (2015) The Soul's Upward Yearning. Ignatius Press, San Francisco.

Timmins F & McSherry W (2012) Spirituality: The Holy Grail of contemporary nursing practice. Journal of Nursing Management. 20, 951–57.

Wordsworth W (2004). Selected Poems (Stephen Gill ed.) London: Penguin Books Ltd., p.157-162.

Therese C. Meehan© September 2017