Nursing: A Story of the Spirituality in Caring

by

Denise S. Morris, RN, MSN

A dissertation submitted to the faculty of

Wilmington University in partial fulfillment

of the requirement for the degree of

Doctor of Education

In

Innovation and Leadership

Wilmington University

August 2010

UMI Number: 3425046

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Nursing: A Story of Spirituality in Caring

by

Denise S. Morris

I certify that I have read this dissertation and that in my opinion it meets the academic and

professional standards required by Wilmington University as a dissertation for the degree of

Doctor of Education in Innovation and Leadership.

Signed: {jTJ^. & M fh. ( /¿aZ^^Pamela M. Curtiss Ph.D., Chairperson of Dissertation Committee

Signed: .^W^. ¿is-Connie W. Kieffer Ed.D., Member of the Dissertation Committee

Signed:

Judith Strasser, Ph.D., Member of the Dissertation Committee

Signed:

Betty J. Caffo, Ph.D., Provost and Vice President of Academic Affairs

This work is dedicated to the nurses who participated in this study and to the sacred

feminine within all nurses. May you embrace your own spirituality so that you may positively

impact the human condition in the provision of caring.

Acknowledgements

I would like to acknowledge significant individuals who have supported me

during this doctoral journey. First, let me thank the members of my dissertation

committee, Dr. Pam Curtiss, Dr. Connie Kieffer, and Dr. Judith Strasser. Each of you was

invaluable in my professional development and challenged me to think deeply. I am

grateful and every changed by your advice, encouragement and scholarly support. To Dr.

Curtiss a special thanks for giving me the courage to take risks and to embrace inquiry

simply because I wanted to know.

In addition, I would like to thank my participants and the members of the

Assembly of the Sacred Wheel. Without your acceptance, support and encouragement

this study would not have been possible.

Further I acknowledge my friend Denise Miller, for all of your support and

encouragement in this process. You have read every word, driven countless miles, and

made my attempts to quit the process impossible. Most importantly however, you have

been there in support of my professional and personal evolution. For this, we will forever,

be bonded together.

Lastly, I wish to acknowledge and thank my family for their undying support in

all my professional pursuits.

IV

Abstract

This narrative inquiry is designed to describe the perceptions of Pagan nurses' use

of spirituality in the process of caring. While the topic of spirituality and complementary

and alternative approaches within nurse patient interactions has been emerging, the

literature is dearth regarding care delivery that embraces complementary and alternative

care influenced by Pagan spirituality. Studies indicate a growing trend in both the use of

complementary and alternative medicine, as well as a growing trend in Pagan spirituality

warranting investigation. These inclinations motivated the exploration of holistic

transpersonal support offered by earth based spirituality and utilized in healing for both

patient and nurse.

Qualitative research methods are used in this study to describe Pagan nurses'

perceptions in a study format that would encourage the use of terms and patterns unique

to the participants in the telling of their story. One broad question was asked and

designed to allow for unencumbered emerging themes. Interviews lasted 45-60 minutes

and nurses' responses were tape recorded. Tapes were transcribed and analyzed using the

constant comparative method to uncover key themes.

The data were examined and categorized according to emerging themes that

offered insight as to collective perceptions of the participants regarding caring and Pagan

spirituality: (a) Pagans identify themselves as spiritually unified beings grounded by their

beliefs, (b) there exists systemic apathy within the healthcare system, (c) there exists fear

of retaliation resulting in complacency, (d) Pagans utilize a blended practice, (e) ethical

lines are blurred, and (f) there is an absence of training in caring in nursing curricula.

?

Information from this study can be used to develop approaches to nursing care

and curriculum which facilitate the development of holistic healing plans for both the

patient and the nurse. Nurse educators can support nursing through the inclusion of

caring paradigms which embrace the spiritual in curricular development. These curricular

changes will assist nurses in understanding their own spirituality, the diverse spirituality

of their patients, and the differences between spirituality and culture. Further, this study

suggests that this paradigm shift may support and sustain the discipline of nursing in a

changing healthcare system and an evolving social climate. Nurse researchers have been

provided with the basis for further qualitative and quantitative studies on this subject, and

a model of narrative inquiry which might be helpful in other areas of nursing.

Vl

Table of Contents

Approval Form ii

Dedication iii

Acknowledgements Error! Bookmark not defined.Abstract Error! Bookmark not defined.

Chapter

I. Introduction Error! Bookmark not defined.

Statement of the Problem 6

Purpose of the Study 7

Need for the Study 7

Healthcare System Change 7

Culture Change 8

Nursing Change 8

Research Question 9

Definition of Terms 9

¡!LiteratureReview Error!Bookmark not defined.

Inclusion Criteria 11

History and Evolution of Nursing Role 12

Connections of Caring with the Spirit 16

Major Theorists 21

Summary 24

VIl

III.Methodology Error!Bookmark not defined.

Background 26

Research Design 28

Data Collection Procedures 29

Risk/Benefit Analysis 32

Data Management/Confidentiality 33

Data Analysis 33

Summary 35

IV. Results.Error! Bookmark not defined.

Grounded Spiritually Unified Beings 36

Systemic Apathy 42

Fear of Retaliation 46

Blended Practice 51

Blurred Ethical Lines 55

Absence in Nursing Curriculum 58

Summary 63

V. Discussion.Error! Bookmark not defined.

Summary of Findings 64

Limitations/Generalizability 70

Implications 71

Recommendations for Further Research 73

viii

References.Error! Bookmark not defined.

Appendix A Human Subjects Review Committee Approval..Error! Bookmark not defined.

Appendix B Advertisements.Error! Bookmark not defined.

Appendix C InformedConsent Error! Bookmarknot defined.

Appendix D Guiding InterviewQuestions Error! Bookmark not defined.

IX

Chapter I

Introduction

To effectively interpret the truly great role that has been assigned her, neither aliberal education nor a high degree of technical skill will suffice. The nurse must also bemaster of two tongues, the tongue ofscience and that of the people (p. 1491)

(Ann Warburton Goodrich as cited in Henderson, 1955)

In examining the positions of recognized nursing theorists, Jean Watson is

perhaps the best known for her position on caring and its connection with interpersonal

relationships (Barnhardt, Bennett, Porter, & Sloan, 1994). Caring is viewed by nursing

professionals as a wide range of behaviors including physical care, therapeutic acts,

caring for others, empathy, and presence (Cavendish, Lonecny, Mitzeliotis, Russo, Lanza

& Luis 2003; Chinn, 1991; Mayeroff, 1971; Noddings, 1984; Summer, 2008). In

addition, patients receiving care have expressed equally diverse thoughts about what

constitutes caring. According to Noddings (1984), patients desire interactions that display

a state of engrossment or receptivity, which encourages becoming a duality between the

one caring and the one cared for. Additionally, Buber (1971) notes that human beings

enter into a profound relationship experience with one another, and the transcendent,

through the actual meeting of one with the other. Buber (1971) calls this encounter the "I-

Thou" experience, which requires people to be actively engaged in life and

communication with each other. For Buber (1971), this interaction establishes a demand

upon humans to engage a "willingness to do as much as we possibly can at every single

instant" (p. 4-5). While the term caring has a wide variety of expressions to describe

nursing service, the bases of these phrases are the central theme for the essence of the

1

2

discipline of nursing. Watson supports combining science and the humanities in order to

provide an existential, phenomenological, and spiritual theory of transpersonal caring

(Barnhardt, Bennett, Port & Sloan, 1994). Like Noddings, Watson's (2007) position on

interpersonal caring is defined as "an intersubjective human-to-human relationship in

which the person of the nurse affects, and is affected by the person of the other, both is

fully present in the moment and feel a union with the other" (p.57).

Despite the logic of this human care transaction theory, the nursing profession has

sustained a division of its philosophy into two widely differing and often-contradictory

paths. These divisions are identified in the literature, as that of nursing science and that of

nursing art. The focal point of this separation in philosophical foundation has been

motivated by the pressure to maintain conformity with the medical model. While early

nursing leaders were attempting to validate the discipline of nursing through the

establishment of empirically based processes of investigation and theory construction, the

origin and the foundations of nursing were subjected to suppression (Watson, 2007).

Nursing scholars pursued the concepts of nursing consistent with the ideals of Florence

Nightingale that included the structured scientific training needed for nursing education.

It also included the methodology of Virginia Henderson who defined the nurse's role as

highly subjective ~ requiring the nurse immerse herself in the mind of her patient

(National League for Nursing, 2007). While nurses were encouraged to be strong

knowledge-based practitioners, the art of nursing eroded and the belief that nurses should

employ those spiritually based methods became less credible under the traditional

medical-scientific model of the time. According to Goodrich (1964, as cited in Watson,

2007) nursing:

3

imbues the simplest acts with importance and instills a desire for the utmost skill

and accuracy of their performance and commands devoted service, broad

perspective, rigorous analysis, scientific findings, fine perceptions, and enduring

tolerance born of understanding, (p. 14)

Watson (2007) posits that [nursing professionals] have been "caught between the

paradigm of medical science with a body part view of a person and the paradigm of the

natural" (p. 14). Both Leininger (1977, as noted in Chinn, 1991) and Watson (1985) state

that caring is the essence of nursing. Sadly, the evolution of the modern healthcare

system has had a negative impact on the realm of the natural and spiritual approaches to

care by encouraging a parallel operation of these models. According to Mcintosh (2004)

"science values cure, not care which the emphasis of nursing is. Many nurses practice as

if healing and care do not exist, in order to gain status in the medical settings in which

they work" (p. 5). This paradigm shift has resulted in limited time at the bedside, a focus

on technical skills and minimalization of the humanistic side of our discipline. Patients

are no longer human beings, but diseases and cases. Empathy has been lost and replaced

with the pursuit of technical expertise in an attempt to validate our science according to

the rules of medical model (Swiadek, 2009).

Additionally, the work place culture of spiritual neutrality and a depersonalized

approach to caring has fostered the suppression of spiritual discussions. Nurses are no

longer comfortable talking about, or encouraging the power of the spirit among their

peers or with their patients (Stranahan, 2001). Yet, nurses who do embrace a spiritual or

alternative center for caring are often feared, seen as having poor professional boundaries

or lacking in nursing credibility. Once again, nursing theories regarding the direct

4

correlation between the spiritual and caring do not provide us the underpinnings for

practice or scholarly research; therefore, our profession and the quality of our patient

outcomes diminish.

Because nursing is perhaps the most intimate of relationships in healthcare, the

holistic treatment of the patient is best suited for the discipline of nursing. According to

Bent, Moscatel, Baize and McCabe, (2007), nursing is an inherently spiritual praxis

which requires nurses to share in experiences of others. It is essential that we regain unity

between the medical science and the social science models and support the universality of

caring rooted in the sacred self. Spirituality, or the sacred self, is defined as a "universal

human phenomenon that recognized the wholeness of the individual and their

connectedness to a higher being" (Cavendish, et al. 2003, p.l 16). Theorists and

practioners of nursing have long emphasized the need for complementary and alternative

forms of caring which embrace the spirit and its interconnectedness between the overall

health of the mind and body. There is considerable research regarding the links between

the spirit and health in humans (Banks, 1980; Benson, 1997; Dossey & Keegan 2000 as

cited in Cavendish, et al., 2003), In the United States alone, a majority of Americans

consider themselves religious or spiritual (Gallop & Castelli, 1989 as cited in Cavendish

et al., 2003) It is this sacred self that nurses must know in order to renew the foundations

and essence of human caring and healing for both patients and themselves. By embracing

the sacred self the nurse can achieve a balance between the scientific and the spiritual and

develop relationships with patients that foster healing plans. Noddings (1984), states,

"caring involves stepping out of one's own personal frame of reference into the others"

(p. 24). This transcendental connection of the spirit or sacred self with the other is the

5

empowering force we possess and yet suppress as nurses today. According to Jung (1968,

as cited in Mcintosh, 2004), the sacred self is defined as the internal God, or spirit that

promotes self-actualization and allows humans to face their soul.

The distinctiveness of our profession has been sacrificed because we do not have

a foundation from which the social and scientific theories can emerge united. We struggle

to define a paradigm suitable for our unique discipline and consequently lose direction

for our practice and research. According to Grant, O'Neil, and Stephens (2004), "Nursing

was born in the spirit and is now looking back to see what has been lost" (p.265). Nursing

professionals, are champions of holistic caring, and therefore must be involved in

upholding standards and ethics, as well as supporting fellow nurses in the advancement of

the profession through the renewed use of complementary and alternative forms of caring

(American Holistic Nurses Association, 2009). The primary goal of holistic nursing is to

support and improve the human condition, and this can best be achieved through the

integration of traditional and holistic modalities (McElligott, 2008). Further, the unity

nurses share in these experiences of caring will propel each professional toward a higher

sense of self (Watson, 1985).

To be truly effective practitioners of caring, the nurse must have knowledge as

well as the ability to internalize the spiritual connections and apply it to themselves as

well as to their practice and to their profession. According to McElligott (2008), good self

care practices allow nurses to become healthy, calm, and balanced, which makes it easier

for them to listen, observe, and assess the physical, emotional, and spiritual concerns of

their patients. To begin this journey, it is necessary to evaluate the diversity of the

6

nursing workforce and to consider those practitioners skilled in the complementary and

alternative modalities that utilize the spiritual as a foundation for caring.

While there has been a recent resurgence in integrated healthcare across the

country (Berger, Leach & Shaffer, 2003), the premise of holistic, complementary, and

alternative approaches has failed to make open connections with the spirit. Consequently,

the history of the spiritual connection in nursing, values in caring, alternative forms of

caring, and healing must be examined in order to determine a framework for connecting

the spirit in partnership with the science of caring. From where did nursing derive its

knowledge for such areas of caring? What are those caring practices? Are these caring

practices universal? What does it mean to be a healer? Were these the lost spiritual

foundations of nursing of which Grant et al. (2004) had referenced? Because the

religious foundation of Paganism is founded in the ontological assumption that all things

are connected to nature and the spirit, Pagan nurses may be more comfortable providing

holistic caring ways and may be more responsive to the humanity and holism in the care

of their patients than their Judeo-Christian, or strictly scientifically minded counterparts

(Whitehead, 2003). Limited understanding prohibits open collaboration between peers

who embrace these alternative forms of spirituality and those who hold to the traditional.

By understanding the perceptions and experiences of Pagan nurses, the path to the

recovery of our historical roots in holistic care methods might be revealed.

Statement of the Problem

The problem of this study is that there is little knowledge about alternative

spirituality and Pagan nurses forms of caring.

7

Purpose of the Study

The purpose of this study is to describe the perceptions of Pagan nurses' use of

spiritual centers in the process of caring, and to demystify the approaches of

complementary and alternative spirituality thereby promoting healing utilizing the power

of the spirit.

Needfor the Study

Research on holistic complementary and alternative forms of caring in nursing

should focus upon the nurse's critical role in the shifting trends in our healthcare system,

society, and nursing practice. In response to these changes, educators can ensure that

nurses own and claim the power of complementary and alternative forms of caring

approaches by first understanding the trends which mold our future. With this knowledge,

nursing educators can then utilize curricular approaches that embrace the complementary

and alternative in daily practice thereby fostering collaborative holistic healing

partnerships.

Healthcare system change. The evolution of our current healthcare system has

sustained a transfer towards the provision of care with an eye on the financial bottom

line, and has had a profound effect upon the outcomes and landscape of the nursing

profession (Swiadek, 2009). Motivation for quality of outcomes has centered care upon

cost containment because insurance companies utilize the shortest length of stay for the

least amount of healthcare expenditures. "Patients are discharged regardless of physician

discretion and nursing recommendations" (Swiadek, 2009, p. 19). While we assert that

our concern is for the total care of the patient including the focus upon the mind, body

and spirit, Vance (2001) notes that 57% of nurses report not providing any spiritual care.

8

While there are many contributing factors related to this dearth of spiritual care such as

burnout and lack of training, the single biggest barrier identified is the lack of time at the

bedside given the demand of the current era of cost containment in a highly technically

focused landscape (Summer, 2008; Oelke, White, Besner, Doran, McGillis, &

Giovannetti, 2008). Consequently, the system is devoid of humanistic approaches and

spiritual care has become impersonal and generic. According to Swiadek (2009), the

challenges of cost containment are resolved at the administrative levels and

communicated to the nurses with impersonal edicts and memos that erode trust and foster

burnout.

Cultural change. Public expectations of individualized spiritual holistic care are

present more than ever (Ledger, 2005; Stranahan, 2001). In fact, 76% of people claim to

have a religion, religious affiliation, or they document a sense of spirituality (Ledger,

2005). Today, we have highly educated healthcare consumers who demand holistic

treatment in the management of disease and the promotion of wellness. Accrediting

bodies like the Joint Commission for the Accreditation for Hospital Organizations

identify explicit standards for spiritual care in the hope that nurses will embrace this

critical area of healing and wellness (JCAHO, 2008 as cited in Vance, 2001; ANA,

2004). While the expectation is present, nurses do not take ownership in the management

of this dimension of healing. We refer these clients to hospital chaplains or simply ignore

the patients' need altogether because of a feeling of inadequacy or confusion (Whitehead,

2003).

Nursing change. The evolution of the healthcare system and the societal

9

expectations noted in the research, necessitates an evolution in the discipline as well.

Nurses are increasingly dissatisfied with their job and researchers note a lack of

fulfillment related to limitation of time, which prohibits the inability to offer holistic

caring (McSherrry, 2006; Nussbaum, 2003). In addition, the research indicates that

nurses feel uncomfortable with the provision of spiritual and complementary alternative

care because of the lack of training and the lack of credibility given these natural healing

modalities (Arnold, 1989; Goddard, 2000; McSherry & Draper, 1998). Further, the

profession itself is in need of spiritual healing. In recognizing these factors, nursing

educators and leaders should reform curriculum that may, in turn, foster the utilization

and research regarding the impact of complementary and alternative medicine modalities

necessary for caring (Frisch, 2001 as cited in ANA standards). In doing so, nursing

students could very well develop the skills necessary to form meaningful relationships

with patients and help them develop healing plans as well as unite nurses in healing.

Research Question

The single broad research question for this study is:

How do Pagan nurses describe healing though the use of spirit based

alternative forms of caring?

Definition of Terms

For the purpose of this study the following definitions of terms will be utilized.

Complementary and alternative modalities. Alternative healing approaches

including massage, aromatherapy, reflexology, energy work, imagery, meditation,

therapeutic presence, Reiki, and therapeutic touch.

10

Holistic nursing. A "legally licensed nurse who takes a holistic (mind-body-spirit-

emotion) approach to the practice of traditional nursing. Holistic nursing is based on a

body of knowledge, evidence-based research, sophisticated skill sets, defined standards

of practice, and a philosophy of living and being that is grounded in caring, relationship,

and interconnectedness" (AHNA, 2004, p.l).

Judeo-Christian. Judaism and numerous Christian denominations that worship a

monotheistic God as noted in various versions of the Holy Bible or the Torah.

Neo-Pagan/Pagan. One of a people or community who observes a polytheistic

religion; a person who is not a Christian, Jew, or Muslim (Adler, 1979; Berger, 1999;

Hutton, 1999; Orion, 1995; Starhawk, 1999).

Neo-Paganism/Paganism. For the purpose of this study, this term is used as an

overarching term that includes Wicca, Druidism, and other Earth-Based Goddess worship

religions. According to Adler (1979), those persons who are unfamiliar with its tenants

often refer to Wicca as witchcraft; however, it is essentially an earth-based religion

whose members refer to themselves as Wiccan's or witches depending upon their

personal preference.

Pagan Nurse. A licensed nurse who observes a polytheistic religion.

Sacred self. A religiously neutral description of what some traditions call the Soul

or High Self.

Spirituality. Interconnectedness with a higher power, God or a god type being for

the purpose of finding the meaning to life and the ability to transcend one's self.

Traditional/Western modalities. Modalities that are recognized as validated by

empirical research, and handed down in the traditions of nursing and medicine.

Chapter II

Literature Review

Never believe that a few caring people can't change the world. For, indeed, that

is all who ever have (p.242).

Margaret Mead (2005)

In Chapter I, the need for research on holistic complementary and alternative

forms of caring, the nurse's critical role in a shifting paradigm, and the need for healing

partnerships were suggested. My belief is that the evolution of nursing as discussed in

Chapter I has resulted in the loss and disregard for the spiritual healing and aspects of

caring in nursing. What does the literature say about the nurses' evolutionary roles and

the impact of the nurses' own spirits in healing? To better appreciate the approaches for

such an implication, the literature was reviewed and categorized to facilitate

understanding. This chapter begins with a review of the history and evolution of the

nursing role, and concludes with examination of major theorists who support a caring

ideal.

Inclusion Criteria

An extensive review of the literature was conducted in order to explore the

existing body of knowledge concerning alternative forms of caring, spiritual care and

Paganism. A search utilizing CINHAL, Health Source Nursing Academic Education,

EBSCO, Academic Search Premier, ERIC and ProQuest databases were conducted using

the following search terms: care, caring, complementary and alternative medicine,

naturalistic care, Paganism, mysticism, metaphysical nursing, spiritual care and

11

12

spirituality. Because of the centrality of caring, the literature regarding spiritual and

caring were limited to articles not greater than 25 years, with the exception of historically

relevant documents and manuscripts. To focus the literature review, research has been

categorized into the following areas: history and evolution of the nursing role and major

theorists.

History and Evolution of the Nursing Role

Throughout history, caring and nursing have been recognized as interconnected

and collectively essential concepts (Hudacek, 2008; Nightingale, 1860/1969; Watson,

1985). While wives and mothers have, and remain the primary caregivers in families and

communities, historically, there were those special village healers who utilized natural

healing techniques which could not be accomplished by mothers and wives (Ehrenreich

& English, 1973; Minkowski, 1992) These lay nurses maintained a commitment to

community that was steadfastly anchored in the term caring. These practitioners were the

local nurses, midwives, pharmacist, abortionists, undertakers, and counselors who

utilized the spiritual basis of folk medicine to promote healing and minister to the dead

(Ehrenreich & English, 1973; Nutting & Dock, 1907). These women were wise,

cherished by their neighbors, and were rewarded largely by love and respect, but with

very little monetary compensation. Nonetheless, they served all who called upon them

with healing and comfort (Nightingale, 1860/1969). They were confidant, magician,

herbalist, and friend. They were the nurses, the quintessential healers of the people.

According to Minkowski (1992), in the three centuries preceding the Renaissance,

the role of nurses was highlighted by two corresponding developments which affected the

understanding of the healer throughout Europe: the birth of the university and the

13

ecumenical campaign to remove women from any position of power in a community.

The first, the establishment of the university and professional schools excluded these

natural female healers from formalized education. This occurrence created the monopoly

of the practice of medicine and subsequently healing as male dominated (Ehrenreich &

English, 1973). Nonetheless, women fought on, maintaining a right to care for the sick.

Prior to this time, healing remedies had been passed from one generation to another

through oral tradition and personal experiences. Minkowski (1992) states,

Because the scientific study of human illness had not yet begun, it is not

surprising that magic, amulets, and incantations were important elements

in the total treatment formulary of all practitioners, including physicians.

(p.288)

The industrialization of medical training would put into question the successes of the

folk remedy and marginalize the impact of the spiritual in total healing (Ehrenreich &

English, 1973; Minkowski, 1992).

The second occurrence, the church campaign, would further oppress the female

nurse and often resulted in the brutal persecution of countless numbers of peasant healers

—witches. Women healers were a political and religious threat to the church and its

leadership (Ehrenreich & English, 1973.). For nearly three centuries the church launched

an opposition campaign that began with a subtle yet effective name change. According to

Alder (1986), the word witch comes from the Old English wicce, or wicca, which derive

from the Latin root wie, or weik, which refers to religion and magic. While

etymologically incorrect, the term witch was often recognized as that of wise one

(Hutton, 1999). While there is confusion and debate regarding the origin of the term, it is

14

clear the archetypal image of witch, as a respected healer was common at the time.

Therefore, this campaign transformed a positive representative term to a feared and

prejudicial term associated with a negative stereotype, degrading these beloved healers of

the 13th century. Witches were attacked for being pragmatic, empirical, and immoral

despite long histories of care and compassion. They were accused of crimes such as

lewdness, political subversion, blasphemy, heresy, and magical powers which affected

health. Perhaps the most preposterous effect of this event was the fact that nurses were

charged with crimes whether perceived as for healing or for helping. In the case of the

midwife, the association with witchcraft was even stronger. In fact, so feared were the

skills of midwifery that the chief church witch hunters, Kramer and Springer

(1486/1928/2008) in their guide to the manual on interrogation and conviction of witches

known as the Malleus Maleficarum (1486/1928/2008), wrote:

For this must always be remembered, as a conclusion, that by witches we

understand not only those which kill and torment, but all Diviners Charmers,

Jugglers, all Wizards, commonly called wise men and women.... and in the same

we reckon all good Witches, which do not but good, which do not spoil and

destroy, but save and deliver. ... It were a thousand times better for the land if all

Witches, but especially the blessing Witches, might suffer death, (p.21)

By the 14th and 15th century, these women healers were branded charlatans andwitches resulting in the loss of effective naturalistic healing approaches (Minkowski,

1992). In evaluating this event, the in-depth relationships were the critical points of

change between the folk healers of the time, and the common people was the critical

point in the change of the nursing role. The peoples' healers were in effect taken away

15

through brain washing and fear and healthcare became increasingly industrialized and

available to the wealthy or influential. Providers shifted from natural healers to those

providers sanctioned by the church, the nuns, brothers and male physicians. Access to

healthcare became possible only in hospitals or convents run by religious organizations

where women were taught to be subservient and powerless. Nurses became the

handmaidens of the physicians and their contributions to healing limited by religious

societal expectations (Ehrenreich & English, 1973). These ideas resulted in the evolution

of the nursing role and the problems discussed in Chapter 1 . Further, these events raise

the questions: from where was nursing caring born, where is it now and where might it

go from here? Are we coming full circle, making pedagogical mistakes which separate

our practitioners; is the evolution of our role out of our control, or can we regain the

power of healing and merge the scientific and the spiritual once again? Nurses must

embrace the best of their past, and incorporate the best of their future into the evolving

role society expects and needs for effective healing. Nurses were, and are powerful

healers who can positively influence the lives of our patients and our community by

understanding and embracing the universality of caring.

Defining Caring

How do we define the term caring? Since the first use of the term "care" in

relationship to the discipline of nursing by Florence Nightingale in 1860, the concept of

caring remains elusive. Nightingale's notion of caring was founded upon religious

mysticism that infused the spiritual in the provision of tasks designed to "put the patient

in the best condition for nature to act upon him" (Nightingale, 1860/1969, p. 3). For other

nursing scholars the term is founded in science and the humanities. Researchers have

16

explored caring through patient outcomes and patient perceptions. However, if caring is

to be retained as the essence of nursing, it is necessary to provide an overview of the

concept of caring and to clarify its individual aspects for application to nursing practice

(Morse, Solberg, Neander, & Johnson, 1990). Review of the expansive literature on

caring resulted in five over-arching perspectives identified as the core of nursing. These

concepts include: caring as a human state, caring as a moral imperative, caring as an

effect, caring as interpersonal interaction, and caring as a therapeutic intervention

(Benner & Wrubel, 1989; Gaut & Boykin, 1994; Leininger, 1985; Morse, et al. 1990;

Watson, 1985/2007). While the research is replete with inquiry surrounding these

perspectives, it is the impact of the caring on nursing as a moral imperative this study will

examine. Caring is not simply a set of behaviors or skills but a commitment to the

patient's dignity and integrity within the nurse-patient relationship. According to Morse

et al. (1990), caring is an emotion that motivates nurses to act, and is an essential

component of an effective nurse. Caring includes the emotions, feeling, and behaviors

occurring within the nurse patient relationship that assist both the one caring and the one

cared for to achieve self- actualization (Mayeroff, 1971). Caring in nursing encompasses

all facets of humanity in the development of caring plans for healing.

Connections of Caring with the Spirit

I have chosen the term connection to describe this relationship between the spirit

and caring, as it implies a joining together of two or more elements thereby creating one

relationship in the moment. It may not be permanent, but it is, as Noddings (1984), notes,

being engrossed in the experience with the other, able to receive his or her reality. Caring

and the spirit are inseparable and must be jointly considered in order to achieve the goal

17

of overall health and wellness. In the provision of care, the nurse is concerned with

ministering to the sick, preventing illness, and ensuring overall health. Health is defined

as the unity and harmony within the mind, body, and soul in a continual state of coping,

adaptation, and growth from conception to death (Kilby, 1997). The nurse- patient

relationship then becomes the method by which patients can achieve a higher

understanding of self and empowerment and find the harmony resulting in health.

According to Watson (1985) transpersonal caring is defined as a spiritual unity between

two persons that provides a means of progress toward a higher sense of self and harmony

with the mind, body, and soul.

Once again our understanding of terms further complicates our expressions of

caring. What is the spiritual and how is it connected with caring? According to

Burkhardt and Nagai-Jacobson (2002) "Attempting to define spirituality is akin to trying

to lasso the wind" (p. 18). Sessan, Finnell, and Jezewski (2007) define spirituality as "an

intricate, enigmatic, abstract and ambiguous concept" (p.252). While the literature has no

consistent terminology defining spirituality, there are common elements woven

throughout these respective definitions. This element includes a connection with a higher

power, the ability to transcend one's self, and defines the purpose and meaning of life

(Mayerhoff, 1971; McSherry & Draper, 1998; Taylor, 1992; Watson, 2007). For the

purpose of this study, the connection with a higher power and the nature of the

metaphysical or existential that empowers an individual to transcend life's circumstances

and find meaning are utilized.

Again, we must look to Nightingale, as the pioneer modern nurse for a

foundational explanation of the connections between the spiritual and caring.

18

Nightingale's work was founded in the spiritual, and suggests that compassion is

universal, and that love arises from an inner God-consciousness (Nightingale,

1860/1969). Therefore, she suggests that all occupations and acts in nursing can bring

one closer to God (Nightingale, 1860/1969). Further, Nightingale suggests that prayer,

listening, and self-awareness are processes of linking the outward personal self with the

inward divine self (Nightingale, 1860/1962). For Nightingale, spirituality is intrinsic to

human nature and is our deepest and most potent resource for healing (Macrae, 1995).

These philosophies open up possibilities for caring and healing within nursing by

including and embracing the power of the spirit.

Despite Nightingale's command of the foundation of caring, the leading

philosophers of the day were responding to a world in turmoil. This critical time in

nursing history resulted after social upheaval following major political and social

conflicts in both Europe and the United States. Like Nightingale, philosophers were

besieged with societal and personal searches for ontological understandings. According

to O'Brien (2003), during times of social upheaval, humans often examine their

spirituality and alternative consciousness for meaning. Theories emerged, and the

thinking of the existentialists, nihilists, and absurdists had significant influence upon the

society, and nursing regarding these transcendental understandings. The impact of writers

such as Nietzsche, and Camus must be explored because of the significance that their

writings had upon the developing spiritual consciousness of humanity of the time. These

existentialist philosophers do not base understandings of religion upon rational

demonstrations, but rather experiential individual human decision-making in the absence

of conclusive evidence (Nietzsche, 1967).

19

Nietzsche's (1967), interpretation of social calamity was an affirmation of life as

one endless cycle of loss and eternal reoccurrence. Perhaps best known for his claim that

God is dead, Nietzsche (1967) posits that there is no possibility of transcendence, and that

life is a series of events that are not subject to renewal and growth. In his book Thus

Spoke/Spake Zarathustra, Nietzsche (1967, p.3) reflects upon the 'overman' and

suggests that life is misery and tragedy, and that humans have no hope of eternal

improvement. Rather man is something to be overcome (Nietzsche, 1967). There is for

Nietzsche, no divine being who will ultimately rescue humanity from a life of eternal

reoccurrence of the same despairing event. Nietzsche (1967) indicates that at one time the

greatest sin was to sin against God, but that God died and sinners died with him. He

conveys the premise that humans are oblivious to this emptiness in life, and thereby

protected from the logical release found in suicidal ideations. In addition, Nietzsche

indicates that the greatest experience possible for man is the point of happiness aroused

by disgust and contempt for his existence (Nietzsche, 1967). These writings display a

tortured discussion between hope and despair, and establish the opinion that human

existence takes precedence over essence. Man is then totally free and responsible for his

own actions (Nietzsche, 1967). No longer able to accept Judeo-Christian ideals,

Nietzsche's writings are a personal reconciliation of emerging Darwinian theories

challenging the God of that time, and humanity's place in a world of responsibility

(Nietzsche, 1967). This human responsibility is seen by Nietzsche, as the source of

anguish and dread that encompasses mankind and nullifies the power of human

spirituality.

20

Influenced by Nietzsche, the thinking that life is a series of pointless events that

end in death continues (Camus, 1955). Absurdism is according to Warnock (1989) found

in the gulf between human expectation and worldly indifference. In other words, Camus

recognized that humans expect logical predictability in their lives only to realize this

falsity and return to chasing our tails [italics added]. While Camus and Nietzsche were

similar in this fatalistic thought Camus believed that life is precious, and it is a dualistic

paradox requiring a greater appreciation for life and happiness. Camus suggests that

humans can accept dualism, but cannot accept the paradoxical. In Le Mythe, Camus

explores how humans experience the absurd and how humans cope with the absurd in

life. Human life according to Camus must have meaning or it has no value. Camus felt

that giving assent to the cruelty of the world was society's ultimate pessimism. Camus

championed human qualities that disempowered this cruel existence. He wrote, "the

world may be unjust but there is a human quality of justness; the world may be cruel, but

cruelty can be alleviated by the human quality of mercy. The world may be absurd but

man is not" (p.74). Camus held credence to the power of the human mind to find meaning

and value in an impossible environment.

Steiner supported Camus' s premise concerning the power of the mind, and

extended Nightingale's philosophies of connections with the spirit and caring science by

establishing a foundation for spirituality as the essence of heart thinking, and thereby the

heart of healing (Steiner, 2000). For Steiner, thinking was, and is a spiritual activity. The

ability of nurses to be authentically present in the moment offers the one cared for the

mindfulness of the one caring, and further supports understanding the value of the

qualities each person brings forth from within (Perkins, 2003). Through spiritual

21

thinking, nurses can assist patients in revealing the paths that bring out these qualities in

making life choices and healing plans.

While the research indicates that spirituality can mean different things to different

people, nursing theorists conclude that a human connection to the spiritual is essential in

caring, healing, and health. There are many things that Taylor (1992 ) claims humans can

do without and be no less human, yet the one thing that humans cannot do without,

except with great suffering is caring, love of nature, and our understanding of our place

within it (Taylor, 1992). Taylor further states, "Without this we become machines,

grinding out our days and hours to that merciful end when death imposes the peace we

have never been able to find for ourselves" (Taylor, 1992, p. 6). Nursing can benefit from

an approach that re-establishes the value of higher spiritual senses of humanity, and links

them with human care (Watson, 2007). Nurses who connect the spirit with caring will

come to know the person well enough to recognize the soul, offer hope, empathize, and

empower self healing in the provision of holistic care.

Major Theorists

To date, there are three major theorists of caring in the field of nursing. The first

is Watson's theory of human care (Watson, 1985/2007). Watson's theory reveals the

implication of relationships and transactions that are necessary between caregiver and

patient to protect the patient's humanity, thereby influencing the patient's potential for

healing. Watson posits that psychological, emotional, and spiritual care is more

significant to healing than technical tasks of nursing care. As a method to implement this

concept into practice Watson (2007) established carative factors as interventions utilized

in the context of nursing care. These carative factors include:

22

1 . Humanistic altruistic system of values

2. Installation of faith and hope

3. Sensitivity to self and others

4. Helping-trusting, human care relationship

5. Expressing positive and negative feelings

6. Creative problem solving

7. Transpersonal teaching learning

8. Supportive, protective, and corrective mental, physical, societal and

spiritual environment.

9. Human needs assistance

10. Existential-phenomenological - spiritual forces, (p.75)

These carative factors are used to assist the patient to gain a higher degree of

harmony between the mind, body, and spirit. The patient is viewed as a whole regardless

of disease or illness (Watson, 2007). While nurses acknowledge the importance of

relationships as part of the caring process, it is the time involved in developing these

relationships that bring the theory into question. Is it possible to establish such a nurse-

patient relationship in the current healthcare system? Morse et al. (1990) points out that

time constraints, staffing shortages, shorter lengths of stay, the unconscious patient, and

the cognitively impaired are unable to interact with the nurse long enough to establish an

in-depth relationship.

The second theory is Leininger's theory of Transcultural Care Diversity and

Universality (Leininger, 1985). Leininger suggests that nursing actions must be beneficial

23

to and congruent with the patient's beliefs and expectations. Further, she contends that

while caring is essentially universal, it is important to understand that patterns and

processes may be influenced by human and cultural variations requiring nurses to offer

care diversity accordingly. The theory offers a framework suggesting assistive and

supportive approaches enabling nursing decision-making and actions while supporting

cultural preservation and maintenance. While the theory remains abstract, the ideas have

raised awareness among nurses to the need to consider issues of diversity in the provision

of all patient populations.

The third theory is Boykin's theory of nursing as caring (Boykin, Schoenhofer,

Baldwin, & McCarthy 2005; Boykin, Schoenhofer, Smith, Joseph, & Alemán, 2003).

Boykin suggests that nursing as caring is based upon the assumptions that theory and

practice are interrelated and that human relationship is essential in caring (Boykin et al.

2003). To be human is to be caring and therefore all persons who are human will at some

level be caring. Further, the theory rests on the premise that nursing is about coming to

know persons as caring, and in that knowing nurturing them. It is Boykin's opinion that

humanness or personhood is living grounded in caring, and is lived moment to moment in

an ongoing relationship with both the one cared for, and the one caring (Boykin et al.,

2005). The focus of nursing then becomes the knowledge and nursing actions that nurture

persons living and growing in caring (Boykin, et al., 2003). Since all nursing takes place

within the relationship of the nursing situation, shared lived experiences offer what

Boykin, et al. (2005) refers to as "caring between" (p. 16). The nurse enters into an

intentional relationship with the world of the patient, and offers opportunities to provide

24

care in relation to what is important to that person through the process Boykin, et al.

(2005) calls "coming to know" (p. 16).

To make connections with the theory, Boykin et al. (2003 & 2005) suggest an

element of the process called the "Dance of the Caring Persons" (p. 18). The Dance of

Caring Persons utilizes the metaphor of dancers in a circle, moving freely as individuals

while engaging in a rhythm that connects all and provides organizing purpose and

integrated function (Boykin et al, 2003). This relationship is grounded in the value and

mutual respect for human personhood. Further, as an organizational framework, the

theory assumes that cultures are composed of many persons who bring unique gifts that

are used to accomplish the common mission of healing.

Nursing practice shifts from the normal perspectives of the medical model, to

understanding that the unique focus of nursing is the nurturing of living, growing

persons. The nurse allows herself to enter into the relationship, know the person being

cared for, and known as the caring person. This mutual participation of the one caring

and the one cared for is the focus of healing.

Summary

The literature indicates that nursing has long been recognized as synonymous

with caring and grounded in the spiritual. While strongly influenced to conform to the

medical models and ideals of a male dominated system, nurses have maintained their

discipline as one of nurturing and holistic healing. In our urge towards the sacred, nurse

and patient can support healing together. Nursing theory has established the framework

for caring elements that are inclusive and supportive of the spiritual domain. No longer

are the quantitative evaluations alone effective for measuring the outcomes of holistic

25

nursing. Embracing the metaphysical and spiritual dimensions of healing and re-

establishing the uniqueness of nursing's contributions to this process are essential to

future nursing development and curricular designs which support human self caring

relationships fostering self actualization and harmony.

Chapter III

Methodology

The storyfield is a particularly powerfulfield of influence generated by a

coherent battery ofmutually-reinforcing stories and story elements— characters, plots,

themes, metaphors, goals, images, events, etc. — that co-habit and resonate within our

individual and/or collective psyches. A storyfield directly influences our lives, often

without our even being aware ofthat influence.

Anonymous

I began this document by introducing the demands and barriers nurses face in the

administration of complementary and alternative caring approaches within the current

paradigm shifts of the changing healthcare system. Chapter II discussed the current

literature regarding the history and evolution of the nursing role and the major nursing

theorists whose ideals are centered in caring. There exists a dearth of literature regarding

Paganism in nursing, and thus supports the need for the study. Chapter III discusses the

methodology utilized for this study and the rationale that supports the chosen research

design. The research process and procedures used in the study are thus explained.

Background and Subjectivity

According to Peshkin (1988), a researcher's subjectivity is like a garment that

cannot be removed and is always present in both our research and non-research lives.

Consequently, it is essential for this study that I maintain awareness of my own

subjectivity. This facet of the research can be accomplished through careful and ongoing

reflection in order to avoid a lone introspective voice that may bias the results.

26

27

As a nurse educator, I am concerned with, and utilize pedagogy and androgogy

that allows me to influence the kind of nurses my students will become; nurses who are

present, engaged, and compassionate for all whom they have the privilege to encounter.

My work with patients and families has offered me glimpses of the transcendental. I have

sat with the lonely and dying, held the hand of the patient in terminal pain, stroked the

arm of the elderly, and eased anxiety and tension through simple acts of caring. I have

communicated impending death to families, have done my best to hold death at bay and

eased the passing of others who held on while suffering intently. I have honored and

attended to the spiritual needs of my patients, and have respected their desires for prayer

or silence. I know that caring is significant to my patients, and I know that it has offered

me great satisfaction as a caregiver. I am forever touched by, and still connected to some

patients whose lives have ceased, but who have left their mark on this earth nonetheless.

In the words of Mcintosh (2004), "There is so much power in the relationship between

nurse and patient, and so much potential for both to be healed by a power greater than

either alone can imagine" (p. 44). By embracing the relationship, both nurse and patient

can benefit from the healing experience that neither can predict.

Therefore, while I am skilled at controlling my feelings even when presented with

a different worldview, it is critical to remain aware of these feelings during the research

process; I must also use caution not to trivialize or misinterpret experiences as noted by

the participants. I approach this research with respect, and I humble myself before those

with whom I share this experience in the hope that I will honor their story as they intend

it to be told.

28

Research Design

I chose a qualitative study to examine alternative ways of caring through the

perspectives of Pagan nurses. Qualitative research has been successfully utilized in

examining the phenomena that are not quantifiable or utilized to make predictions, yet

increase knowledge and understanding of human action. The purpose of qualitative

research is to reveal and interpret phenomena in terms of the meanings that people apply

to them with little disruption to the subjects' natural settings (Clandenin, 2007; Morse &

Field, 1995). Consequently, this method seeks to understand how social experience is

created and given meaning by participants within a specific context, and to allow for the

development of explanatory models and theories (Clandenin, 2007; Denzin & Lincoln,

2008; Marshall & Rossman, 2006; Merriam, 1998; Morse & Field, 1995, Polit &

Hungler, 1999). This type of research is centered on increasing understanding, or ways of

knowing, rather than on predicting or controlling (Clandenin, 2007). Since my desire in

this study is to understand the Pagan nurse's perspectives on the use of spiritually based,

naturalistic caring to promote healing. The qualitative method is most appropriate for the

foundation of this inquiry.

I use a constructivist-naturalistic paradigm for the interpretive framework of the

study because it assumes that there are multiple realities in the natural world (Denzin &

Lincoln, 2008). The strategy utilized will be that of the narrative inquiry which will allow

me to explore the Pagan nurse's perspectives regarding alternative, spiritually centered

caring. Clandenin (2007), Denzin and Lincoln (2007), and Morse and Field (1995)

suggest that narrative inquiry is the storied accounts of our daily lives. According to

Reissman (1993), "Narrative analysis takes as its object of investigation the story itself

29

(p. 1). Therefore, as storytellers, researchers are afforded the opportunity to learn from

the everyday story and the "telling" of the story by its participants. Kvale (1996) further

confirms that in-depth conversation interviewing allows for stories to be co-authored,

resulting in an effective method to reveal phenomena. Consequently, storytelling

becomes a social, powerful act utilized to empower the participants in identifying

linkages in their real world. Narrative research allows investigators to find meaning

through analysis of stories as told by the participants. Since nurses interact with their

patients daily, and are actively involved in their "lives" of healing, this narrative research

strategy promotes understanding and collaboration with the participants.

Participants

A purposive sample of Pagan nurses of all genders and races, who use

complementary and alternative medicine modalities in their nursing practice, are

included. For the purpose of this study, Pagan nurses are nurses who identify themselves

with observing a Pagan religious path. In honor of the significance to the movement and

the energy of the lunar cycles to this religion, 13 participants were recruited. All other

nurses are excluded.

Data Collection Procedures

I chose to utilize purposive theoretical sampling of participants. This purposeful

method of sampling involves the researcher hand selecting participants who are identified

as being able to provide the most significant or useful data (Merriam, 1998 & Polit &

Hungler, 1999). I began my quest for participants by first engaging in relationship

building with a local coven utilizing their direct and indirect referrals. This process

involved 12 months and 1 day, of interactions with an assembly of Pagans including 8

30

different local and regional covens, and 1 European group. Interactions and/or

observations occurred during open and closed rituals, educational workshops, healing

session, initiations, sweat lodge experiences, and other gatherings. I was present at each

opportunity and acted as a nonparticipant observer in all events. I knew none of the

participants personally or professionally prior to their inclusion in the study. After

establishing a trusting researcher relationship, I was able referred to seven Pagan nurses

within the organization. To recruit the additional participants needed I placed

advertisements in two area metaphysical stores, a national web site for Pagans, and on

two separate yahoo groups whose participants are Pagan nurses (See Appendix B) My

intent was to have participants from varying backgrounds and locations in Delaware,

Maryland and Virginia. After much interest resulted from all advertising sites, thirteen

self identified Pagan nurses from the United States and Europe, were selected, each

representing one of the lunar cycles significant to Pagans around the world. This

population included four men and nine women. Two participants withdrew themselves

from the study citing concerns regarding societal retaliation, resulting in eleven

participants at the end of the interview cycle; these included three men and eight women.

While the inclusion of additional participants would have solidified the data, themes

began to emerge after the first six interviews. Interviews regarding their perceptions and

experiences with alternative forms of caring began by utilizing a private setting of their

choice, after full disclosure and informed consent were obtained (See Appendix C).

Interviews lasted from thirty minutes to one hour in length and were audiotape recorded

and transcribed by myself. According to Denzin and Lincoln (2008), audio recording

ensures the accuracy of the interview data. Participants were asked one broad question:

31

"How do you promote healing through the use of spirit-based alternative forms of

caring?" According to Kvale (1996), interviews should be conversational and begin

broadly allowing for the free flow of information from the interviewee. Further, Denzin

and Lincoln (2008), caution researchers against bias, and suggest that neutrality be

maintained and questions non-leading. Therefore, a set of guiding questions that were

utilized as a tool to maintain focus in the interview process (see Appendix D). Based

upon the participants' response probing questions were utilized to obtain additional data

or to clarify participant's statements. Immediately following each interview, the

researcher noted thoughts and nonverbal signals in field notes. While transcriptions did

not occur immediately following each interview, they were completed within the week

following the interview in order to foster increased understanding of the data.

In addition, field notes and other pertinent artifacts such as email accounts from

participants were examined and included as data. While there was no formal relationship

between the researcher and those nurses who were interviewed, the process of

observation, field note documentation, and open dialogue in formal and informal

gatherings promoted understanding of the phenomenon (Denzin & Lincoln, 2008). There

was no deception of participants. Approval from agencies was not needed for this project

since the research was not conducted within an institutional framework; however in

compliance with the federal and university guidelines, approval from Wilmington

University Humans Subjects Review Committee was obtained (see Appendix A).

According to Denzin and Lincoln (2008); Gay, Mills and Airasian (2006); Morse

and Field (1995); Polit and Hungler (1999), the primary instrument used in qualitative

research is the researcher herself. The dangers of bias in this type of research as noted

32

above were avoided by incorporating several sources of data, including interviews, field

notes, and archival data. The use of multiple sources of information to confirm emerging

findings is known as triangulation, and ensures the credibility of the data (Denzin &

Lincoln, 2008; Gay et al., 2006; and Merriam, 1998; Polit & Hungler, 1999).

Risk and Benefit Analysis

There were minimal risks to participants associated with this study. Participants

were given informed consent prior to interviewing and were made aware that should they

feel any distress from the interview they could stop at any time. In fact, two participants

removed themselves from the study, citing personally identified concerns of retaliation

with regard to their respective workplaces. While risks were not anticipated, nor realized

during the research, the participants realized benefits. Nurses verbalized benefit from

discussions regarding caring and professional practice, and were anxious to tell their own

stories of alternative healing, thereby eliminating any prejudice or misinformation

currently considered about this population of practitioners. Further, these nurses benefited

from the knowledge that they are contributing to the development of their discipline of

nursing.

Data Credibility

In order to ensure credibility, the data were co-authored with the subjects, and

transcripts of interviews were given to participants for evaluation and confirmation of

facts and recordings. These member checks were conducted throughout the study as

recommended in Merriam (1998). In addition, a panel of peers in nursing and education

was employed to review the transcripts, the theme analysis, and the participant

confirmation documents to further lend credibility to the data. Furthermore, the

33

utilization of multiple data sources and methods, known as triangulation "secure an in-

depth understanding of the phenomenon in question" (Denzin & Lincoln, 2008, p. 7).

Moreover, Denzin and Lincoln (2008) state, "Triangulation is not a tool or a strategy of

validation, but an alternative to validation" (p. 7).

Data Management and Confidentiality

Audio-taped interviews, journals, and field notes are kept in a locked cabinet

located in the researcher's home for evaluation by expert auditors and advisors for a

period of three years after the study, after which time they will be destroyed according to

Wilmington University protocol. In addition, all participants' identities were protected

through the use of a pseudonym of her/his choosing. No demographic or identifying

information was collected on the participant nurses other than their years in practice, and

their state or country of residence at the time of the interview.

Data Analysis

In qualitative inquiry a continuous review of the data is recommended (Denzin &

Lincoln, 2006; Marshall & Rossman, 2006; Merriam, 1998; Polit & Hungler, 1988).

Further, data collection and analysis work hand in hand to identify coherent

interpretations (Marshall & Rossman, 2006). Therefore, it was essential in the study to

continuously analyze the data and make adjustments in observations and interviews

accordingly (Clandinin & Connelly, 2000; Marshall & Rossman; Merriam, 1998).

Firstly, this analysis involved reading and re-reading all of the field texts so that

they could be categorized and coded for themes (Clandinin & Connelly, 2000). Because

of the great volumes of data in qualitative inquiry, the funneling of information into

common themes became necessary when trying to make sense of the collected

34

information (Morse & Field, 1995; Polit & Hungler, 1988). The goal of organizing the

data is to enable the recognition of the relationships within the data that Clandinin and

Connelly (2000) refer to as narrative coding. This process is known as the constant

comparative method and permits the identification of similarities and differences and the

elimination of unnecessary data (Merriam, 1998; Morse & Field, 1995; Strauss & Corbin,

1997; Van Mannen, 1988).

As this inductive process continued, the analysis, theme identification and coding

revealed new understandings that necessitated a change in the original research plan to

include electronic mail accounts (Marshall& Rossman, 2006). These changes involved

the validation of understandings by peers and educators and further member checks for

accuracy. Saturation occurs when no new information is revealed (Guest, Arwen, &

Johnson, 2006). While descriptive coding was utilized early in the constant comparative

method, interpretive coding began later in the process and identified meanings found by

the researcher (Polit & Hungler, 1988). Descriptive coding are similar words or phrases

used by participants, where interpretive coding includes meanings identified by the

researcher (Denzin and Lincoln, 2008). It was recommended that careful filing is

implemented to allow themes that fall into differing categories be accurately recorded and

transferred from category to category as necessary (Polit & Hungler, 1988). I utilized

both paper and electronic filing, since a majority of confirmations and clarifications were

received via copious electronic mails. While sometimes cumbersome, this allowed for the

transfer of information from one file to another, and further assured the accuracy of the

interpretations of the data. I printed individual transcripts in different colors, then coded

them and cut them into strips filing them in labeled folders. Because of the nature of this

35

manipulation of the data, backup copies were recommended and were kept for validation

purposes. The final step in this process involved attaching significance to findings

making inferences, drawing conclusions, and reporting findings. Themes and patterns

will be discussed in the following chapter.

Summary

The methodology, procedures, and instrumentation have been discussed in this

chapter and can be utilized for future audit purposes. In addition, approaches to ensure

trustworthiness of the data, analysis, and coding were explained and steps to ensure

confidentiality were revealed. Findings will be discussed in later chapters.

Chapter IV

Results

"Their Story"

The purpose of this study was to understand nurses' spiritual centers in the

process of caring and to demystify the approaches of complementary and alternative

spirituality; thereby, promoting healing utilizing the power of the spirit. To understand

the perceptions of Pagan nurses, qualitative data were collected and analyzed bi-weekly

over the course of an eight-week period. Data were open coded using the constant

comparative method. Next the data were examined and categorized according to

emerging themes that offered insight as to collective perceptions of the participants

regarding caring and Pagan spirituality. The emerging themes included: (a) Pagans

identify themselves as spiritually unified beings grounded by their beliefs, (b) there exists

systemic apathy within the healthcare system, (c) there exists fear of retaliation resulting

in complacency, (d) Pagan nurses utilize a blended practice, (e) ethical lines are blurred,

and (f) there is an absence of training in caring in nursing curricula. Thereafter, the data

analysis was provided to members, a group of nurses, and educators for validation of

theme identification. To protect the participants, individually chosen pseudonyms have

been used in the discussion that follows.

Grounded spiritually unified beings. In all cases, the participants identified the

concept of spiritual unification with the Divine and a clear perception that this

transcendental interaction is inborn and embraced early in life. In many cases, they

acknowledged generational influences that supported this unification with the spiritual.

Further, participants acknowledged this interconnectedness with the Source, Divine,

36

37

Goddess, and The One empowered them to positively influence themselves and others

because, "we are all a part of the same energy"(Jim M, personal communication, October

22, 2009). While the participants acknowledged this ability as possible for all human

beings, they indicated that societal constraints and fears might have resulted in inhibition

of these abilities in the populous. Further, the participants attributed this ease of divine

connection with the Pagan path spirituality.

Vicki has worked as a nurse for more than 15 years in neurology intensive care,

long term care, and wound care. She indicates that her ability is a result of a direct

connection with the divine that has been evident since birth. During the interview Vickie

stated, "I was born with it! Seriously, as a very young child, on my pets, it was just

something that was very natural. I did it easily; I just knew that I was connected and that I

could heal them because of that." It was evident, by her body language and facial

expressions that she comfortably embraces her spiritual connection and even exhibited a

sense of pride during the interview. Vicki needed little encouragement in the interview

and freely shared generational experiences that she believes these connections are passed

down from generation to generation. "My lineage is that I'm the eldest daughter of the

eldest daughter and that goes on for eons. Each of us has had the gift." When asked

about this feeling of generational power, Vickie responded by saying, "Well, it is

significant to me that all of the first born females have this ability, and I know that it is

what grounds me and makes the spiritual central in all my actions; I know my daughter

has the same ability; she just hasn't been called yet." Vicki was able to reflect in

subsequent e-mail documents her continued grounding as a spiritual being as she shared

future employment opportunities. When asked for clarification, Vickie indicated that in

38

all her life and in her adversity, the "Goddess shows us a way—if we just listen and

remain connected."

Simon, a nurse educator and member of the military reserve, indicated "The belief

in the interconnectedness of all as one in the Source allowed me to connect with my

patients on a much deeper level. Since we are all the same energy dispersed in different

vessels, I had a much greater investment in their care, for in caring for them I am caring

for myself and the Source as a whole." Simon attributes the Pagan path as the framework

for this interconnection and indicated that his job as a nurse and caregiver to the sick

"brought me to the Pagan and non-Christian belief systems." Simon was able to reflect

upon his spiritual upbringing in Christianity as establishing a sense of disconnection from

others. I never truly related to the emotional experiences of others. . . never had a true

soul-to-soul or emotional experience with a client until I began to care for a recently

transitioned. [Paganism] is a spiritual path that has the most truth for me. It grounds and

connects me to the world, the Divine, and others."

Lady Passion, a nurse advocate, high priestess, author, and long-term public

Witch stated, "I was born pathetically powerful in the waking state. So, I never really had

choice but to accept what I was. A Witch." While she acknowledged her inborn ability,

she further identified this connection with the Divine as liberating, allowing her to act as

a spiritual being not only grounded by her beliefs, but also empowered by them.

I don't feel that my Craft grounds my practice, but rather, liberates it: Whereas

other nurses often feel confined to enact a medical model, I delight in my wide

range of treatment modalities, depending on what my client is amenable to or

from which they benefit.

39

Lady Passion reflected on the power of spiritual unity and expressed the need for

nurses, Pagan and not Pagan, to embrace this power for the overall well being of

humanity. She shared a personal motto in her teaching and caring of, "Let none stop you

or turn you aside." She uses this motto as an exhortation that gives ". . .impetus to others

to constantly strive to act on behalf of clients." She described this connectedness with the

Divine as the force who gives her strength and relentless persistence on behalf of clients

and the blessings of success when others lose heart or burnout".

Gretchen indicated that her inborn values and spirituality led her to the Pagan path

because of its beliefs in the connectedness with the Divine and a natural alignment of this

unified spiritual sense. "I've been a nurse 22, almost 23 years, and I've been Pagan for

15-16 years. However, upon becoming Pagan, I realized that so much of what I already

was, was already Pagan. It was just in line with Pagan values naturally, and it just fit; it

reflected all that I believed and was exhibiting." She reflected upon the fact that for her,

these beliefs were inherent and existed beyond understanding in her nursing practice. She

further noted, "When I came to nursing I hadn't found Wicca as a path yet. . . you know

the funny thing is that Pagan values were already there and just had not been labeled as

such. I had always done things from a holistic point of view, and once I found Wicca, I

guess it was not such a leap to incorporate that into my life. . . .it made a lot of sense."

Jim M, a nurse of over 30 years in both public and private practice, also indicated

that he identifies himself as spiritually unified since birth. He stated,

I think my whole life has been an experience with the spiritual and with caring.

Ever since I was a child. . .even at the age of 6, people would come to me for

answers about visions and healing. I am tuned into the spirit of nature and feel

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most comfortable in those environments. I get answers from the elementáis and

from the ethereal spirits; so it's easy for me to help others who want help. All I do

is talk to the spirits, and they guide me.

He commented on the impact of this spiritual unity and view of the world by

stating, "Being Pagan impacts everything I do as a nurse, as a person, and as a

healer. . . You can't separate it. So. . .all my experiences are spiritual, and as a part of that

greater energy force, I have no choice. I think really all nurses do this in many ways even

if they don't realize it or they don't think they can embrace it. I find connections with the

Divine in the world the spirits speak to me, and I see the Goddess in all things."

Autumn Rain is a long time Pagan, but relatively new nurse of 5 years who was

previously a massage therapist. She stated, "Being Pagan is who I am. I don't get up

thinking I am going to do thus and such; I just do what comes natural to me. Healing has

been a part of who I am for longer than I have been Pagan. My mother tells me that when

I was 4, 1 would sit outside in nature talking to my invisible friends and coming up with

potions I was going to use to treat people." While the perceptions of Autumn Rain also

validate this natural connection with the spiritual, she reflected upon a lengthy period of

study exploring these encounters with the Divine in her adult years. She noted, "While

studying, Paganism began to speak to my heart. It made sense, and it felt like coming

home." She described this feeling of coming home as the ". . .moment when one knows

something is right, that all of the foundation we put our faith in is solid and firm, and

connected to something bigger than we imagine; yet small enough dwelling within each

of us."

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Jim W is the high priest of a coven, and a nurse for more than 30 years, described

his connection to the spirit as ". . .the only one that makes sense for me! ! As an openly

gay man, it is the only religion that is totally accepting and focused upon a pure

connection with the Divine, without prejudice or narrow mindedness; just pure love and

pure trust." This nonjudgmental concept of pureness in love and trust are central to the

ideals of all Pagans within the participant group. Like Jim W, all participants express this

understanding of pure love as a personification of the Divine here on Earth.

Morgan, a new nurse in a birthing center, defines her spirituality as a connection

to the web of life. She stated, "First and foremost, it is my own most basic premise from

the beginning to the end of each day. It informs all of me, and so it informs all my

relationships, as well as my nurse-patient ones." Morgan reflected on the impact of such

a premise as something that "allows me to see my patients as autonomous and yet

connected to the web of life." While the spiritual connection for Morgan is evident, she

also expressed the importance that this connection has upon her ability to remain

objective and yet still caring in her nursing practice. "It [connection with the spiritual]

has helped me maintain caring while keeping professional boundaries. I could not

possibly come to nursing with any other tools than those I have structured around my

spirituality —it is natural for me."

Rowen is a high priestess of a coven in the northeast region of the United States,

with vast experience in psychiatry and hospice and is currently a bereavement counselor.

She indicated that "Paganism is all that I am and all that I do. . .it gave me the basis for

caring for the spirit." Rowen explained that often nurses are unsure about the approaches

to spiritual care and that because it is not a physical process; they either make a referral to

42

clergy for spiritual care or sadly, deny it. For Rowen, Paganism "makes spiritual care

tangible when it is not seen that way by the world." She reflected upon situations where

caring for the spiritual allowed patients and families alike, the connections needed for a

smooth transition and recovery. "I can help my patients talk to spirit and to speak to the

spirit on their behalf; it helps them make the transition." Rowen further described this

connection with the spirit as a duty and a demand of Pagans around the world. She

indicated that in her role as high priestess, "I teach our need to care for the world and to

be the best we can at helping others, no matter what our gifts may be."

Systemic apathy. Based upon the interviews, field notes, and observations, the

theme that most frequently emerged from the research was the concept of systemic

apathy. Pagan nurses voiced strongly, the concern over the changing healthcare system

and the resultant apathy within nursing. Without exception, all nurses in the study

verbalize and reflected upon the changing face of healthcare delivery and the loss of what

the participants called human caring. Terms like cold hearted, mechanical, and highly

technical at the expense ofhuman compassion were common vocabulary within this

theme.

Jim W noted that with the changing healthcare systems, "Nurses have become the

widget counters, the legalized pill pusher, and the robot of the algorhythm. Where is the

humanistic piece? It makes a difference." Jim reflected upon his concern at a trend

where nurses are the technical experts and the administrators of medications. He noted

that, "In our Western tradition, there is a pill for everything and yet there is so much more

nursing can do." Constraints, such as time at the bedside and demands upon nurses for

technical prowess, have undermined the very foundation of nursing— that of caring.

43

Healthcare success is measured in days, not human wellness or true wellness outcomes.

"We patch 'em up and get 'em out. . .never once stopping to hold their hands or teach

them how to maintain their wellness." In addition, Jim stated that nurses have been

taught and forced to access ancillary services, while effective nursing caring might have

managed the patients needs equally well; immediately and at the bedside. "The sad thing

is that today we just shift our patients off to the mental health counselor or the chaplain,

when what they really need is just someone who cares at that moment. While Jim

acknowledged the satisfaction of increasing one's technical skills, he is concerned that,

"there is just so much more that we can do, so much more that we can offer our patients

just because they are human. It is this connection that makes the difference and offers the

hope of healing."

Like Jim, Peggy, a nurse of 40 years devoted to patients with disabilities in long-

term placement, agrees. Peggy responded when asked about nursing care, such as

evening preparation and relaxation care given before bed—"OH forget that! ! ! When I

first started work, all patients got p.m. care; including a back rub, straightened linens, and

a snack, now that's all gone... it's very sad." Peggy indicated that the nursing shortage

and the changing demands of the current healthcare system have made delivery of

humanistic nursing care even more difficult.

There is just not enough time! We have to get the paperwork done because of the

regulations and something goes by the way side. I had 8-10 patients and somehow

I made time; newer nurses haven't been taught, and a lot of older nurses are just

tired of fighting the system. I get disturbed and think if I don't go do it myself it

won't get done. How can you leave an older patient lying on a bed full of knotted

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sheets just because you need to write down they've been medicated or turned?

Shame on us nurses for letting this happen! We need to demand the time to care

for people, or we need to reassess what it is we are really doing with our time.

Jim M concurred and brought forward the concern that nursing reform must also

address this paradigm shift. He suggested that nursing programs and nursing

organizations must champion the desires of nurses to provide caring and stop trends

towards the technical and away from the empathetic.

Unfortunately, in the past 20-30 years of nursing, reform has been plagued by

this need to validate our profession through scientific empirically based research

forsaking the spiritual. Our researchers write loosely about the spiritual

connections to healing, but do we really embrace it? I don't think so. . .1 think if

you check the research, you will find very few nurses actually even listen to the

patient's spiritual concerns. We refer them to a hospital chaplain for a quick

generic Band-Aid of spiritual care and move on to the next machine or computer

or gadget that we manage.

Gretchen, a former pediatric nurse, also supports the concepts of this emerging

apathy. She reflected on high-stress cases that are managed day after day, resulting in a

feeling of becoming overwhelmed. While Gretchen noted these actions are often

unintentional, she agrees they are emerging and need intervention.

Sometimes we just get so caught up in the leadership or triplicate paperwork, that

the physical—well you know—we have to do the trach care, the circuitry change,

or give the meds; it's all so technical not to say that the spiritual isn't there. . .it

does get overshadowed by all the stuff you have to get done.

45

She believes that nurses at the bedside are so short staffed and overstressed by the

increasing demands that humanistic approaches to nursing caring get easily lost.

"As a supervisor I would say, 'Are you kidding me, you didn't remember to turn the light

on, touch the patient, or do whatever is so basic to nursing?' Oh, where has our

profession gone?"

Like the other nurses in this study, Gretchen verbalized frustration and concern

for a return to basic nursing caring in an environment where the "pendulum has swung so

far, your just trying to survive in a job and not lose the human connection; we have to fix

this ourselves somehow."

Morgan reiterated that current healthcare systems have changed the face of

nursing negatively. She stated,

I always felt that medicine, or the way in which we cared for people, seemed very

cold. It felt to me as a caregiver and a patient that people are just treated as

numbers. After all, you spend hours waiting in an emergency room to get five

minutes with a doctor before you're ushered out with a prescription in one hand

and a bill in the other. What happened to just treating people with care and

compassion?

It is this lack of compassion that is the result of systemic apathy and is changing

the face and focus of nursing today. Morgan reflected on an interaction with a co-worker,

who when questioned about her lack of compassion, stated, "This is just my job, a

paycheck! If that makes me a cold-hearted bitch, oh well." To Morgan and the other

participants of this study, this behavior is unacceptable.

46

Fear of retaliation resulting in complacency. Another consistent theme among

participants was an underlying and continuing fear of retaliation that fostered a sense of

complacency. Participants reported specific incidents that validate these feelings and note

that personal strength and commitment to the spiritual within a "non-friendly"

"prejudicial environment" requires some form of complacency for career survival. Mikki

noted in her interview that,

I find that alternative spiritualities are down played, often ignored in our modern

version of healthcare. It seems that if one does not practice Christianity, one is not

entitled to spiritual care or even concession made for ones spiritual beliefs.

As a nurse, it is assumed that I am Christian or that since I am not Christian, I

cannot be caring of another person.

In addition, Mikki reported a reaction from coworkers who "either try to convert me or

save me, or they see my religion as a curiosity to be mocked, made fun of, and laughed

at." For all participants, Mikki expressed frustrations regarding prejudice and retaliation

at the institutional level as well. She noted,

I am forced to observe Christian holidays in scheduling and work assignments

but am not shown similar courtesies. The people I work with have had little

respect for other religions, and when I point this out, I am told that I am too

sensitive and need to just shake it off.

Mikki reinforced her feelings of prejudice by comparing examples such as

holiday recognition and expectations by stating,

Being Pagan has actually closed more doors than it has opened. As a Pagan I am

expected to participate in the predominantly Christian celebrations and forced to

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recognize their holidays in an institutionalized manner. For example, the Christian

holidays are often the ones that are the overtime holidays. Whereas, having to

work on one of my holidays is seen as something that just happens and isn't that

important. Likewise, hospitals celebrate the Christian holidays with

commemorative ornaments for the tree or a special meal being served; insisting

on observing my religion and being respected causes distance between me and the

staff I work with. This makes the work situation uncomfortable.

Vicki further reported "Pagan nurses work in the shadows. It is a reality, we have

not forgotten the burning times, and even now I am undergoing persecution." When

asked for clarification, Vicki reported that despite her exceptionally low-wound infection

and reoccurrence rates for her long-term care patients, she is being retaliated against

through unjustified claims of patient neglect at the institutional and state level. Vicki tries

to keep her spirituality as "quiet as possible while still doing the work" and notes that "I

would and do get written up for everything, because my gifts are not part of the best

medical practice standards even though they work." As she reiterated these stories, it

became evident that these types of accusations are commonplace within her experiences.

"Once someone finds out that I'm not just different, that I am Pagan and using alternative

energy techniques to heal my patients, the drama starts; I get in trouble." When asked to

expound upon her commitment in the face of such adversity she stated, "We can only let

the results speak for themselves, and it is not about glory—it is about healing. So for me, I

am accomplishing that and just trying to keep myself safe in a mundane world."

Lady Passion told a similar story when she stated that "Anti-Witch sentiment

remains high in medical establishments, and only successful lawsuits will stop illegal

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persecution in the workplace. I'm all for this and encourage many to do so when they

complain of enduring it [persecution]." When asked for examples of what she terms

persecution, Lady Passion stated that her "colleagues feelings were mixed... G ve been

falsely accused of sticking patients with pins and wrapping them in sheets, and dancing

around them in a parking lot, and much worse." Lady Passion noted that while she is a

public Witch, she "never mentioned my beliefs on the job, but that did not stop others

from making a big deal about it." While working as a care plan coordinator for a 77-

patient facility, the utilization of her "psychic prowess" was viewed by her as both a gift

and a curse. In her interview, Lady Passion stated that "When my advocacy cost me the

job. . .and eventually my entire "regular" nursing career because I was wrongly fired for

advocating for a 93-year-old woman's health upon being asked by her physician nephew

about her failing health." As she told me more of this story, her recommendation to the

family was to seek a second opinion and then was seen as "talking out of turn against a

doctor," resulted in her being "black balled for two years." After a lengthy legal pursuit,

Lady Passion was exonerated and led the charge in a precedent-setting case resulting in

the modification in state public law that protected the rights of nurses. As I inquired about

the law, Lady Passion noted that in her state, "Nurses could be fired for their hair color,

not to mention their religion."

Rowen reported that this prejudicial feeling causes her to consider carefully Pagan

terms in the workplace. She notes, "I am always careful with the "W" [Witch] word;

people tend to accept the word Pagan better." As a senior nurse working in a well-known

Northeast psychiatric care facility, Rowen reported that spiritual care was "totally absent

and in a facility that claims to be aware because of fear. . .not to mention that most nurses

49

don't know what spirituality really is and certainly don't want to work with a Witch to

find out."

Peggy concurred with Rowen that Pagan labels and acknowledgment often results

in collégial tension and retaliation. Peggy reflected that during her first years of

employment in a state-run home for the chronically ill, her colleagues were "a little

afraid, and when taking a break they would sit reading a bible to a zealous point almost

you would say, and they were pretty nervous at the time." Peggy reported that one nurse

even responded to her use of therapeutic touch given after patient consent by "asking me

what I was doing and blocked me in the room."

Simon indicated a similar reaction from colleagues and noted that,

I really don't discuss my beliefs with my colleagues. The few times I was asked

and tried to explain, I received a look of disbelief and a statement that laughed off

what I was saying as if it were a joke.

Simon's body language and tone clearly exhibit a sense of defeat and sadness

when discussing these stories. He verbalized a need for secrecy that was complicated

with a sense of personal betrayal. He perceived this act as denying the importance of his

own truth and spiritual influence. This disappointment in his own actions, as well as his

colleague's actions, is highlighted by a situation where he and other nurses "registered a

Wiccan patient as non-denominational Christian, because they felt uncomfortable with

the word Pagan in the medical record."

Jim W discussed this internal struggle and the effect of fear even among members

of a large Pagan organization on the East Coast of the United States, who have a wide

array of social support. He stated, "Several of the nurses, even in our own assembly,

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might not be open to discussing their spiritual practices because of fear and retaliation.

Some have careers and families that they are concerned about protecting." Jim W

indicated that as a Pagan and a gay man, his experiences with this prejudice and

retaliation have become so commonplace that he has developed coping mechanisms that

effectively protect him from this intolerance. He stated, "For me it is easy! I came out of

the closet and then the broom closet-- prejudice is just something I accept as expected

among the sleeping."

Like Jim W, Jim M indicates an ability to cope with this prejudice but indicates

he, too, is a minority among Pagan nurses in this feeling. He stated, "most nurses who

utilized any alternative methods are very cautious about telling others, particularly if they

are Pagan." When asked to clarify this statement, he responded by saying, "They have

children, professions, and family or friends who might not understand. This is still a

small community and a conservative society."

Lastly, Autumn Rain's experience exemplifies this common theme of prejudice.

She stated,

There are not many who I work with who know I am a Pagan. However, at work

one day, a certified nursing assistant with whom I had worked for a while, saw

my pentade tattoo that I have on my upper arm as my sleeve had gone up slightly.

After that, she avoided me as much as possible and would make comments about

Hell whenever in my presence.

While some of the participants have developed approaches to deal with this

intolerance, it is clear that it does exist and is manifested in healthcare systems for Pagan

nurses.

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Blended practice. Pagan nurses, in this study, identified a common coping

strategy to come to terms with the existing intolerance and personal commitment to

Pagan ways of healing by developing a blended practice. In all circumstances, the

participants indicate that they engage in healing techniques in conjunction with their

tradition nursing practice. Further, field notes and observations revealed the existences of

such blended practices within healing environments in and outside of healthcare

institutions. Pagan nurses were present and provided caring at local festivals, gatherings,

and sweat lodge experiences utilizing both their clinical and technical skills, as well as

their alternative forms of healing. The participants verbalize satisfaction regarding a

growing trend among Non-Pagan nurses utilizing complementary and alternative

treatment modalities; yet sadness that these nurses have not embraced the spiritual

dimensions necessary for truly effective caring.

According to Jim W,

Nurses have morphed into a spiritual venue and don't even know themselves or

what they believe exactly. It is amazing to me that what they are doing is so far

left of Christianity, and they don't even realize it. They might be practicing CAM

[Complementary Alternative Medicine] and not even acknowledge the spiritual

center that is guiding them. You know, it's a tad of this and a smidge of that. . .a

little therapeutic touch and a little crystal healing without even understanding

what they are doing.

In considering the evolution of nursing practice, Lady Passion indicated that this

blending of science and the spiritual is developing. She noted,

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Just last week a new chaplain at our local hospital e-mailed me and wants to work

with me, as he gets so many patients who designate themselves as Pagan or

Wiccan upon admission. It's a good thing working together is what it's all about.

In addition, she indicated that it is because of this blending of her practice that

patient outcomes are improving. She stated, "I am able to help folks solve their problems

not only because I am an experienced R.N., but [also] a trained Pagan clergy and Witch."

She continued by expressing the relationship that develops among her and her patients

and its impact upon their healing plans and success. She stated "Folks trust me because

their confessions are sacrosanct, and I am a consummate professional committed to

improving the human condition." While she acknowledges this trust is important in

success, she emphasized that blending and individualizing care are central to healing.

Many believe that the medical models that we've been drilled and killed in has

been irrevocably broken due to corporate corruption, bad business practices, lack

of staff and supplies, low morale; and increasing demands on nurses by

employers, laws, and state boards. For nursing truly to survive, it must recognize

the benefits of time-tested herbal treatments and home remedies; people's

knowledge and sense about their own bodies in relation to wellness and illness;

and palliative care that increases a patient's sense of well being, such as touch and

non-touch comfort measures.

Further, she recalled situations where the blended roles were called upon in rare

or unusual cases with great success and surprisingly embraced by the patient as well as

the traditional staff. In one situation, she reported that while traditional approaches were

being utilized, she was contacted by the facility to assist. She recollected going in and

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"burning incense, lighting candles, and chanting Barbarous Words of Power, which many

hospitals askew or resist. While I have to fight the staff sometimes, in a few cases, they

see that it works. I haven't lost a patient yet; although, some are 80 years old and have

never had surgery before. . .quite extraordinary."

Vicki indicated that blending of her practice is natural and done with little thought

or concentration. "It just is... I just do what I know to do and tell my peers and patients

that's just me and what can I say. . .it works." While her natural connection is personal,

she does support the notion that,

Nurses must integrate everything together, or we are missing a huge component

[of healing approaches]; because, if you're not one without the other, you can't

just go around hugging and touching without the science. It's about patient

outcomes, we need to do anything and everything we can. . .science and energy

work together.

Vicki acknowledged the need for scientific Western approaches, but also

acknowledged that "some things cannot be healed on a scientific level. . . [the problem]

might be in their psyche, their energy field, their mind, or something else."

Leigh agreed with Vicki in that there are many Pagan techniques that she has

found helpful in caring for patients, but that the integration of both the Western

techniques and the naturalistic approaches make for "best medicine." She noted that on

several occasions, she has modified rituals for Non-Pagan patients and their family to

assist them in accepting the transition [process of death and dying] to the next level,

without completely negating their own spiritual beliefs. She stated,

54

Because it wasn't appropriate for the patient and their family, I rewrote the ritual

of the bowl of water to help them acknowledge and praise their dying family

member. I used the energy of the elements to help them bless their loved one.

Utilizing this technique, Rowen did not feel the need to discuss her Pagan beliefs

but utilized them to assist her patients. This blending of practice and spirituality is the key

to true nursing caring. In another situation, Rowen described a patient who was suffering

through the dying process because she "could find no peace and was restless and

burdened by her life experiences." Rowen again utilized elemental energy by,

Teaching the patient to visualize the spirit of Earth in the North, Air in the East,

Fire in the South, and Water in the West, and she was able to see the ethereal

realm and to be still and quiet. It was very relaxing.

Autumn Rain concurred that a blended practice is essential and significant in

positive patient outcomes. As a hospice nurse, she reflected in her e-mail,

I work in an environment that is quite upsetting for patients and their families.

There can be a lot of anger, resentment and depression. Negative energy can

attach to anyone. . .at times I wait until the patient is asleep, and I spray a mixture

of blessed and consecrated salt water to dispel the energy there.

This is not the only alternative form of healing utilized by Autumn Rain. She also

described using various forms of therapeutic touch, incense, and aromatherapy. She

reported, "I have found that these and other techniques like the use of essential oils have

worked in some instances, where medicine has not."

In Jim M' s vast career in nursing and energy work, he has supported the blending

of nursing practice as necessary for successful outcomes.

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It's not just for Pagans any more, many hospitals now have integrated medicine

departments that are beginning to utilize these approaches and patients are doing

well. Healing is occurring! Not [only] because of these modalities alone, but

[also] because they are utilized in conjunction with Western medicine. So it's not

really a secret, it's more like they [nurses] are embarrassed or afraid someone will

think they are crazy for believing and using something so simple. But the bottom

line is, it works! ! ! ! You can't argue with that.

Gretchen, Brian, Peggy, and Morgan express a similar sentiment throughout their

interviews and all indicate that blending their practice is serious and thoughtful and that

they look at every patient individually. In the words of Mikki, "as Pagans we follow the

Wiccan Rede of 'An it harm none' ensuring safe and thoughtful practice that will honor

humanity while avoiding karmic fall out."

Blurred ethical lines. The nursing profession was founded upon principles

honoring the patient's rights for personal control over healing plans. Given this

foundation, the common themes surrounding the ethics of alternative caring must be

explored. Without exception, all participants stood firm on the patient's inerrant right to

make personal decisions based upon informed consent. However, participants believe that

patient uniqueness and the caring atmosphere must be considered when obtaining

informed consent. Gretchen tells us,

I have struggled with that; if I go into that [informed consent] with a mother and

explain that I am going to move a little energy before I give an injection, 99% are

nullified by that. They have no understanding of what I am even talking about. I

was always taught to ask for permission and, then I sort of reconciled that if I am

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doing something that is not going to hurt my patient, then how is that wrong?

Why should I ask permission for something that is inherently caring?

While it is clear that Gretchen, like the rest of the participants, support the ideal

that consent is an ethical obligation, the general consensus of the group focused upon the

approaches nurses utilize in obtaining such consent. Gretchen indicated that our societal

culture might have extended this principle beyond its actual intention, of maintaining

patient rights under medical ethics. She noted,

I think our society has become consent focused over the top. If you were a patient

in any healthcare field where you need to get the care, would you want to have

everyone ask for permission for the simplest acts of caring?

Overwhelmingly, the group agrees. Gretchen added,

If you are doing the right thing, it shouldn't even be an issue. If I were planning to

concoct my own potion or light incense where the smoke would be detrimental to

my patient, then of course I agree we need permission. But offering compassion

and those things that are naturally part of caring for another person are part and

parcel of nursing practice. Compassion is almost an implied consent form.

Additionally, the discussion shifted to the manner in which nurses ask an unaware

patient for permission to offer caring modalities. Peggy shared that most of her patients

suffer from dementia and or developmental disorders with limited cognitive

understanding. In these cases she requests consent by "breaking down the approach into

terms they can understand." Further, Peggy reported utilizing the principle of implied

consent in such cases. She says, "If they had their right faculties they would give

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permission, but they don't, so anything that I can do to make them feel better would be a

plus and certainly give permission, if possible."

Jim W and Jim M both concur that permission is still a patient's right, and that the

issue for Pagans is simply the way that nurses ask for permission. It is this questioning

skill that Jim W and Jim M believe should be taught to new nurses. Jim W feels that

"even if you are doing something to someone that works, you still need to ask

permission." He further noted that "you just can't do something to someone without

consent, but sometimes nurses are morphing over from their Craft activities to their

nursing activities, and they forget we need to honor that patient's right." Like Peggy, he

tries to,

Explain what I want to do in a way that they understand, like 'if you will allow

me I might be able to help you feel better, this won't hurt and I won't be touching

you.' I might ask them to do visualization while I move energy. In this way the

patient is engaged and we are doing the right things as we have been taught.

Like Jim, Simon agrees that,

Consent is a patient right and that nurses are required by our ethical roles as

professionals to maintain trust within our nurse patient relationship. Without open

transparent communication this is not possible. I don't do anything to someone

without permission of some kind. This consent might be verbal or obtained from

their caregivers or family, but nonetheless I ask. Some examples where I use this

are protection rituals, use of energy oils, and crystals and charged stones

Once again, Mikki referred to the tenets of the Wiccan Rede that states a Witch's

intention is subject to a threefold law of return. Mikki interprets this statement by adding,

58

"This means that, if I did something wrong, karmic results would come back to me three

times as strong. It is this guiding principle that makes patient consent even more

important to Pagans." It is postulated by the participants, that informed consent for

treatment is a patient right that requires special methods of communication and that is

sometimes less than nurses ethical standard recommends. The participants of the study

recognize the importance of ethics in nursing, but agree that these standards necessitate

special consideration when utilizing alternative approaches due to limited patient

understanding. Pagan nurses disagree to which level ethical lines may be crossed, and

under which circumstances. As Gretchen noted, "The [ethical] line is fuzzy and as a nurse

I have to come to a position that I can live with and that is right for my patient."

Absence in nursing curriculum. For more than 20 years, nursing reform has

focused upon curriculum and theory development that guides the evolution of nursing

practice. Pagan nurses within this study concurred that this basic educational paradigm is

central to inform nursing, but that the time for change is imminent.

As an instructor of nursing, and a military nurse, Simon has noted curricular

revisions that have recently included complementary approaches within psychiatric

nursing classes. He stated, "I think that as more and more people disclose themselves as

Pagan, nursing programs will be forced to allocate more time to Non-Christian faiths."

Simon reflected that;

Christian privilege is declining as the society evolves and changes, and while it is

unlikely that it will ever completely vanish, it is not unreasonable to assume that

Pagan ways, which inform thinking and actions, are destined to motivate

curricular changes in nursing.

59

Gretchen agrees with Simon that the Pagan movement is growing, and that this

growth will effect curricular changes in nursing; but she also indicated that this change

should be a process of looking back to what was "thrown away" in the past. Gretchen

suggested that nursing programs,

should emphasize as a foundation this piece, Humanity! I think more global ideas

of bringing your spirituality to your practice are part of diversity. Nurses do not

leave their spirit at home when they go to work; we are diverse, and so are our

peers, we need to embrace each other as well as our patients.

In addition to these thoughts, Gretchen feels that caring is impossible without

touch. She stated "you cannot duplicate that [human to human] connection without

touching... simple acts like bathing a patient. These acts offer so much compassion and

true healing can come from that encounter, rather than just checking off a task."

Gretchen is a firm believer that nursing reform needs to start small, look back, and

embrace common mainstream modalities first. Modalities like "massage, presence, and

therapeutic touch are things without the 'oogyness' that might freak some people out."

Vicki is in agreement regarding this need for human touch as a concept needed in

nursing curriculum reform and suggested,

People today are brought up with the fear of touch. We teach our children to not

allow others to touch them; yet, forget to teach them the benefits of human touch.

It's really become a no touch society. We are becoming more machine like, and

getting away from basic human instinct.

60

Vicki believes that nursing curriculum must "go back to the drawing board and

teach our new nurses the importance of touch and how to utilize their ability to interpret

energy and reconnect with humans."

Morgan and Autumn Rain agree with Gretchen and feel that "student nurses need

training to understand the theories attached to, and the effects of, simple skills." But also

they believe that "students need classes which provide them with the opportunity to do

inner work on their own spirit, to understand it, to explore it, so that they can then help

others." Morgan's understanding of professional boundaries, coupled with spiritual

awareness allowed her to "remember that I am just a cog in the wheel of healing [and]

that includes the patient's will, the family and community support, karma, and Divine

will." Morgan raised a concern for misinformation in nursing programs. She stated, "we

teach our new nurses that over the counter supplements, herbal preparations and natural

remedies are wrong, and in some cases bad, when in reality in the right doses for the right

ailments they are equally effective and often much safer. Let's give nursing students the

entire picture and let them decide."

Autumn Rain supports the idea that, "An understanding of holistic treatment as a

structure of the curriculum is essential, no more talk, show action, if we show them how

important holism and alternative medicine is, and how to utilize it, reform will be

successful".

Lady Passion strongly agrees and stated that,

Nursing curricula should acknowledge the negative side of Western medicine

including; infant mortality, costs, access limitations, elective and dangerous

procedures, and the positive impact of complementary and alternative approaches.

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Further, our students should be aware that herbs are the basis for many

pharmaceuticals, so individual shouldn't be prevented from utilizing them under

supervision.

Her passion for fair, open information and education were evident in her

demeanor. She firmly encourages this passion in the modification of nursing curriculum.

Peggy agrees with open and simple communication techniques utilized at the

bedside, and suggests that they should also be used in the classroom. She sees the death

and dying process as another area in need of training within nursing programs. She

suggested,

Death is a part of the human experience and nurses are taught to care for the body,

but few are taught the importance of passionate expressions of compassion for the

dying. We need to teach them how to have the conversations, and how to handle

their own feelings, and most of all how to listen passionately.

Jim M concurs with the sentiments above and included his opinion that, "until we

get back to our nursing theories and stop trying to compete with medicine, our curriculum

and our reform is doomed to struggle." Jim continued by stating that, "Nurses are nurses

and caring and compassion is our gift; every day I push forward and try and help as many

as I can, but we need nurses who are willing to go back to our roots." When asked where

this training should occur Jim M indicated, "If we did this training at the basic level,

nurses would be empowered to help with the spirit and holistic approaches for quicker

results in patient healing."

Rowen sees nursing reform as needing to clarify the distinction between

multiculturalism and spirituality. She noted, "We absolutely need to add spirit to the

62

curriculum, and not just as lip service. We need to teach respect for Paganism as with any

alternative religion. Nurses need to claim their power and we need to show them how."

Rowen verbalized a belief that Pagans need to lead the change in nursing, and utilize the

teachings of Jean Watson that foster respect for caring. She believes this power can be

facilitated through spiritual care, and stated that "nurses can do things that help the

human condition, and we need no longer be ashamed of those gifts. . .we need to put them

central in our curriculum. . . and make it happen."

According to Jim W the blending of approaches must begin in curriculum

development. Jim asked, "How do we blend things and then get them into the

curriculum? His response to this rhetorical question was,

Well, if we look at the old nursing texts and ways of caring, many of these

approaches were used then, and we've gotten away from them. Things like sitting

with the patient, holding their hand, letting them know that we care just because

they are human, we need to look back to go forward.

While Jim W acknowledges the difficulty of this task, he refuses to "participate in

the complacency, and I will push for a paradigm shift at whatever level I can. By bringing

nurses of all spiritual centers together, we can effect change. I think it starts in personal

practice, but it needs to evolve to the curriculum."

Summary

This study represents one approach in revealing the voice of the Pagan nurse in

caring and professional practice. Collective perceptions of the participants regarding

caring and Pagan spirituality were explored, and major themes were discussed in this

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chapter. In the chapter that follows, implications for nursing and nursing curriculum will

be discussed. The emphasis will be upon suggestions for nursing curriculum, integration

of spiritual training in nursing preparation programs, and integrative health departments

within institutions of health care. In addition, the implications for further expansion of

nursing empowerment, the purpose and benefits of self-exploration and development of

spiritual centeredness among nurses will be discussed.

Chapter V

Discussion

Summary ofFindings

The purpose of this qualitative study was to describe the Pagan nurses perceptions of

caring, and to demystify the approaches of complementary and alternative spirituality by

Pagan nurses; thereby, promoting healing utilizing the power of the spirit. A summary of

the findings has been provided in prior chapters, and the discussion of implications of the

study as well as available literature was provided. The study design utilized one broad

research question "How do Pagan nurses describe healing through the use of spiritually

based alternative forms of caring?" This approach allowed participants to freely tell their

story with little interference or bias from the researcher or the interview format. The goal

was to engage in open dialogue with participants regarding their professional practice as

Pagan nurses.

As a nurse and a researcher, my work has centered upon assisting patients in

healing. In my professional and my personal life; I write, I research, and I study

approaches which might improve the human condition for myself and others. According

to Clandenin (2007) this process of reflective inquiry and understanding is dynamic and

inherent to human development physically, psychologically, intellectually and spiritually.

In this study, I became the conduit for a story of amazing clarity and courage. This study

is a tale of love and compassion. It is a pledge to humanity without prejudice, and a call

for empowerment. I am honored to have had the opportunity to engage with, observe and

communicate with nurses of alternative spirituality. The participants have revealed a

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65

lived spirituality, focused upon globalized caring in and outside of their professional

practice.

In reflecting upon the emerging themes of the study, I found that all participants

consider themselves unified spiritual beings grounded in their beliefs. Without question,

these nurses have evolved to a level of spiritual awakening not commonly seen in our

society. They see no separation between the physical and the Divine and express an

obligation to function doing the work of their own personal "highest and greatest good"

(Lady Passion, personal communication February 22, 2010). They attribute their nursing

experiences, and the effects of energy work as a reinforcement of their own spiritual

beliefs (Simon, personal communication December 7, 2009). This idea supports the

theories of Watson (1985) and Nightingale (1860/1969) who identify a direct connection

of the spirit with the provision of caring ways. Additionally, the participants express an

indwelling energy of the Divine, which positively influences them in personal and

professional practice. Further, the participants indicate the acknowledgment of this

indwelling energy is supported by the tenets and self defined structures of a Pagan path of

spirituality. In some cases the participants identify inborn traits related to spiritual unity

and they express a sense of prior life experiences, which have influenced their abilities

and /or commitment to humanity. These finding support Noddings (1984) premises of the

inseparability of the spirit from the act of caring, and the development of caring

relationships within the moment. The participants are encouraged, supported and

empowered by this religion, and report it to be tantamount with the term caring. The

members find satisfaction in practicing at both ends of the extremes in healthcare and are

comfortable with death, dying, and critical healing situations that other nurses often find

66

challenging. The contributors see themselves as compassionate and needed in the system

and in the development of the nursing profession.

It has been reported that today's healthcare environment is plagued by a lack of

empathy and an apathetic dehumanized approach to care (Swiadek, 2009). Each of the

participants reports the existence of systemic apathy resulting from the changes within

the healthcare system. The participants concur that the highly technical demands and

cultural impact on healthcare has resulted in a lack of human caring and compassion.

They believe that nursing has succumbed to a process of mechanistic care resulting in a

lack of compassionate care. They concur that the work of nursing as it was historically

founded has reverted to insignificance. Highly technical environments, governed by

documentation requirements are controlling the healthcare delivery in this country at the

expense of the patient. According to the participants, care has been dehumanized. Like

Watson (1985) these nurses see the importance of human compassion in healing. They

report that significant healing and wellness will occur if the "old ways" are embraced by

nurses and offered to patients. Despite the extensive research regarding the positive

effects of compassion on patient outcomes, nurses are continuously and increasingly

being taken away from the bedside (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002,

Summer, 2008, and Swiadek, 2009). There is a perception that in order to maintain their

credibility nurses are being pressured to evolve their practice into highly logical,

technical proficient treatment paradigms that are more in line with the medical model.

The passion in the voice of the participants is clear and strong, "nurses are nurses

not physicians" and they have a special Divine gift for healing. Nurses must look back,

recognize their differences, and embrace their power to heal. The role of the nurse is

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essential and needed, not as a handmaiden to the physician, or the manager of the

technology, but as the bedside healer able to impart compassion and positive energies.

These nurses are attempting to regain the positive impact of human caring, while coping

in a system that now diminishes the benefits of such approaches. Their hope is to unify

and empower nurses and to honor and encourage nursing's gift to humanity.

As a result of such expectations the nurses in this study experienced fear of

retaliation as a result of their beliefs. In order to be true to these belief systems and to

their commitment to human compassion and caring, they report facing prejudicial

treatment and in some cases retaliatory action. These concerns often result in

complacency, and silence, despite a perceived ability to improve patient care.

Participants in this study reported hurtful actions and comments from fellow nurses. In all

cases, the participants attribute these responses to a lack of understanding and

preconceived ideas related to Pagan spirituality. Further, the participants note that in

addition to hostility, there seemed to be a tendency to minimize the nature and effect of

these alternative caring approaches (Frisch, 2001 as cited in ANA standards). Because of

limited understanding or fear, a significant number of nurses in this study are potentially

discarding what they perceive to be effective modalities. While there is no desire for

personal recognition on the part of the participants, there seems to be a sense of sadness

that positive results are not recognized or embraced thereby restricting access to

modalities, which might benefit all patients. In addition, they believe this lack of

acknowledgement undermines the power and importance of nursing as a profession. The

reality however, is that these nurses believe they are trying to maintain their own personal

68

safety and exist in the "mundane world". As noted by Swiadek (2009) the participant's

sense that complacency becomes their tool for survival.

Findings from this study support the work of Leininger (1977, as noted in Chinn,

1991; and Watson (1985) who found that professional and personal endurance are needed

to realize practice modifications which result in a blended nursing practice. To accept

today's culture of healthcare and the barriers noted in the study themes, participants

employ practices that blend the technical and the spiritual, supporting the work of

Noddings (1984). Study participants reported providing alternative care at outside events

such as festivals, meetings, and gatherings, utilizing both technical and alternative skills.

Further, they continue compassionate and alternative care while providing care inside

health institutions. It seems that these nurses choose specific patients and specific

moments for the provision of a variety of approaches. They report doing them and

perceiving success. Perhaps the most joy noted by the participants is the fact that the

nursing culture is beginning to recognize enough benefit from these modalities that

terminology modifications have occurred, allowing for broader acceptance of different

types of caring. This action has encouraged a growing trend among non-Pagan nursing

utilizing integrative medicine or complementary and alternative forms of healing. While

the participants find this encouraging, they remain aggravated that the health community

has not generally embraced the spiritual dimension which might lend power to such

techniques. This supports research completed by Cavendish et al. (2003) who identify

limited evidence of spiritual care within the current healthcare delivery system. Pagan

nurses understand the necessity to choose their words and terms carefully in order to

foster acceptance and understanding from patients and colleagues. It is unlikely that any

69

of the participants would utilize Pagan terms while offering care within traditional

institutions. Despite this careful utilization of terms, Pagan nurse believe that a blended

practice is the best approach to nursing care regardless of one's spiritual base. It is their

opinion using both traditional and complementary approaches offers the patient the

greatest possibility for healing. Further, the participants recall circumstances where the

alternative forms of caring helped relieve suffering when traditional medicine failed.

Above all things, there was a concurrence that whatever modalities or nursing assessment

techniques are utilized must in no way harm a patient.

In considering their responsibility to both their professional and spiritual code,

Pagan nurses acknowledge some personal struggle surrounding their training in medical

ethics and the provision of alternative forms of caring. While all participants support the

patient's right to informed consent for medical treatment as noted by the ANA (2004)

code of ethics, the participants felt that a patient's uniqueness and the care delivery

atmospheres might interfere with, or affect understanding of the modality to be

performed. This supports the thinking of Leininger (1978). For example, if a patient is

demented or does not understand the modality and might be willing to accept or deny

care without true comprehension, the participants felt that the method of obtaining

consent might be simplified. However, there were three nurses in the study who indicated

that the concept of informed consent was extended farther than the ethical foundation of

this patient right. They believe that care and compassion are not the same as medical

treatment and care, and are a part of basic human needs. This theme resulted in extensive

discussion regarding the need to ask for informed consent for the provision of

compassion. Some of the nurses in the study view the alternative modalities in question

70

as care delivery that is holistic and part of human compassion. Care such as providing

personal care, feeding or observation and reporting, are approaches that these nurses do

not believe necessitates informed consent.

In addition, the issue of questioning and communication techniques was revealed

and the participants' believe that nurses are not taught or are uncomfortable with the

skills set needed for appropriate discussions surrounding informed consent. There was a

perception that nurses are taught so devoutly the medical model of ethics that they have

not been able to formulate nursing ethics that are in conjunction with, but specific to

nursing (Summer, 2008). While they support the notion that patients are ultimately in

control of their care, the participants believe that the process has become so mechanized

that it has lost its goal of clear communication for effective decision-making in

developing healing plans.

As noted in the previous theme, the idea that nursing curriculum is devoid of

training in complementary and alternative forms of caring was clearly heard in the Pagan

nurses' voices. As noted by National League for Nursing (2007), Pagan nurses believe

that nursing reform is needed and imminent. They support the profession in that the

curriculum of a nursing program becomes the structure on which all nursing work is

built. Additionally, they believe that the emphasis of nursing curriculum might better

focus upon nursing and compassionate care and be cautious about moving closer to a

medical paradigm. The study participants believe that a growing population of Pagans,

the increase in integrative health programs in and outside of formal institutions and a

culture of self-healing may encourage this curricular reform. Pagan nurses look forward

to this change of paradigm and believe it could be healing to the profession of nursing.

71

They see this as a method to embrace diversity as a profession, to engage in meaningful

dialogue and to empower the profession as separate and complementary to medicine, yet

different from the medical model of care, which again supports the theories of Watson

(1985). Nurses are often gifted at providing holistic care, yet required to find this

training independently after licensure. It has been noted in Bent, Moscatel, Baize &

McCabe, (2007) that nursing is inherently spiritual and requires a unity between the

medical and social models requiring guided training and exploration. Pagan nurses feel

that compassionate and alternative healing should be a part of the regular nursing

curriculum, and that educational approaches exploring these modalities could perhaps

empower all nurses personally and professionally.

Limitations

The size of this study was both strength and a limitation. The narrative

methodology gave me the ability to gather data of rich and intricate meaning. The Pagan

nurses' voices were clear and passionate. They were anxious to participate and readily

claimed ownership of the story. The use of this methodology allowed for direct use of

participant's words and my interpretation of the findings. Participants reported feeling a

healing to their frustrations. Because this methodology obtains such rich data, a large

population of participants would have made the study difficult to complete and may have

affected the individual voice of the participants.

Generalizability

The small size of the study does not invalidate the findings, but cannot be

generalized to any other similar group. Studies of this nature do not prove or predict, they

72

simply tell the story of a small group of nurses' perceptions. The nurses that I interviewed

were purposefully selected but of a very closely guarded population of people. While

they were from various states and countries, the criteria of inclusion requiring Pagan

spirituality may have biased the story out of fear of retaliation in their career or home

lives. Similar studies could be conducted among Pagan nurses who are more publically

open with their spiritual path.

Implications

For nurses who function from a spiritual or a technical form of caring, it is

essential that they perceive having done all that may be possible for a patient. Their

empowerment and self-actualization as a nursing professional is achieved by this

commitment to their patients. As suggested by Noddings (1984) and Watson (1985)

nurses like their patients, become whole and one with the life energy exchanged in the

caring experience. While the healthcare system has attempted to remove nurses from the

bedside over the past 20 years, nurses have struggled to hold on to what is innately

nursing. Nurses' value caring modalities such as: physical touch, massage, assistance

with ambulation, being present, listening and holistic relationship building with their

patients. The essence of nursing in the words of Watson (2007) is caring, and the nurses

in this study viewed this process as one of humanistic holistic attention to their patients'

needs through relationships. Connecting with the heart, mind, and body of the patient is

not a new concept, yet the connection with the spiritual remains ambiguous and may limit

the possibility of real healing.

Nurses could be supported in this area of need by curricular advances, which

identify and uncover the personal spiritual connection of the nurse so that she might

73

better facilitate spiritual healing for patients of diverse populations. This study suggests

that it is challenging to assist or respect others' spiritual foundations without

understanding one's own premise. Nursing programs could separate spiritual discovery

from multicultural care and offer learning opportunities for dialogue and exploration of

the spirit and its influence upon the caregiver as well as the care receiver. In practice,

nurses evolve spiritually because of human interaction. They are challenged, they are

strengthened and they are changed. This process necessitates preparation at the

instructional level, in order to prepare nurses for this transformation. Without this

preparation nurses are faced with this personal process alone. As a profession, I believe

that this study reveals the internal strength and support Pagan nurses find in their

spirituality when experiencing this change. It may also benefit humanitarian support for

nurses of all faiths.

In addition, this researcher thinks that the power of the spirit is a powerful healing

force that nurses can use in relationship building. While the debate regarding professional

boundaries is important, many professional organizations support and allocate a place for

spirituality in caring. However as previously noted by Stranahan (2001), more than half

of nurses fail to provide such care. This researcher thinks that this response by nurses is

directly related to our lack of preparation in handling and separating cultural care from

spiritual care. Further, this researcher suggests that the healthcare delivery and

instructional systems' ambiguous position toward spiritual care may contribute to this

deficient response by nurses. While spirituality is a part of culture, it is not the entirety of

culture. Nurses may need to understand the difference, and be empowered with

74

instructional experiences to effectively help in the healing processes of diverse patient

populations.

Additionally, nursing may need to be supported with an understanding that both

patients and nurses within these caring interactions could obtain healing. Today's

healthcare system is in need of healing. Without curricular reform nurses will be unable

to assist with or to gain from spiritual healing. Personal and professional growth occurs

when needs are met. Nursing programs may help meet the needs of the nurses'

spirituality by supporting relationship experiences regarding spirituality within the

curriculum. The restoration of the right relationship with patient, colleague and institution

requires connection with the spirit. Programs that eliminate, marginalize or devalue the

importance of the spirit may only contribute to the continuing failure of the healthcare

system (Wallace, Campbell, Grossman, Shea, Langue &Quell, 2008). As nurses learn to

value and activate their own spirit, and to respect and to honor their patients spirits, true

healing plans might be developed and outcomes improved and sustained.

Recommendationsfor Future Research

Over the past two decades many research studies have been conducted regarding

the patients perspective of spirituality and caring. These have included empirical studies

on the effectiveness of nursing interventions regarding spiritual caring and yet little has

been done to study the descriptions of the nurses themselves. This study offers great

insight into the perspectives of Pagan nurses upon our roles and responsibilities in caring

for our patients as well as the nursing community.

First, more studies focusing on the spiritual growth of the nurse are needed so that

nursing leaders might help nurses make individual spiritual connections from healing

75

encounters. Nursing leaders have the power to bring healing to nurses, both

professionally and personally. What nurses do in their daily interactions is

transformational and in need of reflections and support. Understanding one's spirituality

requires approaches that are experiential rather than those non-participatory spiritual

experiences utilized in most nursing programs. Nursing leaders might support this

process through preparatory interventions that should be studied and tested. For example

studies which evaluate clinical conferences, spiritually centered literature reviews,

spiritually centered patient assignments and post care self reflections might inform

nursing instruction.

Second, studies evaluating the role of nursing within a culture of caring should be

conducted. This approach for research could integrate and explore the subcultures of the

nursing profession. By utilizing a collégial dialogue, nurses could work towards

improving practice and regain nursing significance within healthcare. Through these

studies nursing leaders could impact future nursing and the role nursing plays in the

changing healthcare systems of today. More studies of this nature might be of vital

necessity to the survival of a profession that is suffering from a lack of people entering

nursing practice, severe shortages of nursing professors, and an increasing number of

nurses exiting the profession from career burnout. The perceptions of nurses are vital to

understanding and identifying a course of action in a changing paradigm of caring.

Third, more studies on holistic approaches to healing should be conducted within

health care institutions which evaluate the patients' perceptions in regards to their

healing. Society is increasingly embracing and utilizing alternative approaches to

wellness and healing. However, upon admission to an institution, patients are often asked

76

to leave behind such approaches. Despite their potential positive effects on patient

outcomes, caring methods like herbal supplements, massage, reiki, therapeutic touch and

meditation are dismissed as lacking in credibility or effectiveness within healthcare

systems. Research focusing on integrative healthcare departments and its associated

outcomes might reveal data that might encourage care delivery modification and patient

inclusion in healing plans.

Last, studies should be conducted within nursing programs that have already

integrated complementary and alternative modalities into the provision of care. These

studies could illuminate the impact of nursing empowerment in the utilization of these

techniques for healing. These studies could allow for benchmarking, resulting in data

driven decision making to inform instruction as recommended by (Gay et al., 2006).

Modeling in instruction is a powerful tool in exposing and valuing behavior of student

nurses. Programs that have been successful should be studied to increase understanding

of approaches used to support student assimilation. Since many nursing educators feel

uncomfortable with discussions surrounding spirituality, faculty could share practices that

foster the development of spiritual sensitivity for and of their students.

The knowledge gained from this study suggests that Pagan nurses are a minority

of practitioners who truly embrace a lived spirituality and engage daily in all approaches

to foster patient healing. In addition, nurses have learned that caring involves the

exploration and unification of sacredness surrounding the work of nursing. According to

Watson (2007) nurses work with both their own and the patient's energy and human life

force that has its own inner path for living and dying. It is this transcendental connection

with the spirit that facilitates true healing. Nursing is "truly a spiritual practice, thus

77

illness, pain, suffering ,birthing and dying are all existential spiritual human dilemmas

that ultimately each of us shares and must face" (p. 17). Pagan nurses are connected with

energy, and have much to offer the nursing profession through understanding and

implementation of alternative methods that give nurses a mindful practice to help

themselves and their patients heal.

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Appendix A

HSRC 6

WILMINGTON UNIVERSITYHUMAN SUBJECTS REVIEW COMMITTEE (HSRC)

PROTOCOL REVIEW

This section is to be completed by the HSR Committee Person.

Principal Investigator: Denise S. Morris

Date submitted: /</l-/o?The protocol and attachments were reviewed:

The proposed research is approved as:

____Exempt _£__ Expedited Full Committee

The proposed research was approved pending the following changes:

____See attached letter

____Resubmit changes to the HSRC chairperson

The proposed research was disapproved:

____ See attached letter for more information.

HSRC Chairor Representative /-/><L· M- /Ar*^X

Print name

Signature Date: _1____1_

HSRC Chair ?? ', , , /Ì „ .,Or Representative M>tJutL 5. IgMfWfiPrint name

Signature Date: __l_¿__/_

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Human Participant Protections Education for Research Teams Page 1 of 1

¡ffi?fi National Cancer InstituteINSTI IIJ It U.S. National Institutes of HeaitH I www.cancer.govEi

Cancer Toptcs ::öjrncatWa|$. Cancer.Stetistic, Research « Funding Npws

Human Participant Protections Education for Research 1

Completion Certificate

This is to certify that

Denise Morris

has completed the Human Participants Protection Education for Research Teamsonline course, sponsored by the National Institutes of Health (NIH), on 02/22/2008.This course included the following:

• key historical events and current issues that impact guidelines and legislation onhuman participant protection in research.

• ethical principles and guidelines that should assist in resolving the ethical issuesinherent in the conduct ofresearch with human participants.

• the use of key ethical principles and federal regulations to protect human participantsat various stages in the research process.

• a description of guidelines for the protection of special populations in research.• a definition of informed consent and components necessary for a valid consent.• a description of the role of the IRB in the research process.• the roles, responsibilities, and interactions of federal agencies, institutions, and

researchers in conducting research with human participants.

National Institutes of Healthhttp://wwvv.nih.gov

Home I Contact Us | Poiicies | Accessibility | S_i.te.He.lp | Site MapA Service of the National Cancer Institute

t¿_k! 'FlKSTt .' ?

http://cme.cancer.gov/cgi-biri/cms/cts-cert5.pl 2/22/2008

88

Appendix B

Advertisements

SEEKING: PAGAN NURSES

Of Any Path

(Wicca, Isis, Celtic, etc.)

I WANT TO TELL YOUR STORY!!!!Research Study: The Sacred Self in Caring: The Perspectives of Pagan Nurses

The purpose of this study is to promote understanding of the impact of the nurses'spiritual center in the process of caring, and to demystify Paganism and the approachesof complementary and alternative spirituality thereby promoting healing utilizingthe power of the spirit. Increased understanding of caring can be used to designstrategies and curriculum approaches that are more therapeutic for patients andempowering for nurses

Confidentiality: Your identity will be kept strictly confidential!!! and you will beassigned a pseudonym of your choosing. Further, all data sources will be maintained in alocked safe until the completion of the study, after which time they will be destroyed.

This study is for my doctoral dissertation and offers additional protectionthrough the Human Subjects Review Committee of Wilmington University in compliancewith all Federal guidelines.

Participants: Nurses that have been practicing Pagans and use complementary andalternative medicine modalities in their nursing practice.Time Commitment: Approximately 45minutes

Location: A private setting of your choice

Benefits:• Your VOICE will be heard !• You will be able to reflect on caring aspects of your practice that are healing to

yourself as well as your patients• Your opinions will contributing to the body of literature in nursing, and may

influence future curriculum and nursing empowerment.

Primary Researcher: Denise S. Morris RN, MSNIf you or anyone you know are interested in participating in the study, please

contact Denise S Morris at (302)-542-1269 or email at dmorr35187@wildcats.wilmu.edu.An informed consent form will be administered prior to your telling me your story.

Appendix C

PARTICIPANT INFORMATION AND INFORMED CONSENT

Dear Participant,

As a doctoral student at Wilmington University, Georgetown, DE, I am interviewingnurses about their perceptions and experiences with caring. I hope to understand information thatcan be utilized in designing nursing curriculum that embraces complementary and alternativetechniques that are therapeutic for patients, and satisfying for nurses.

Participation in this study is strictly voluntary. If you choose to participate in theinterview, I will ask you a question about your perceptions regarding caring and spirituality. Thisinterview will last approximately 1 hour. These interviews will be audio- tape recorded to ensureaccurate documentation of your responses.

You have been invited to participate because you have identified yourself as a Pagannurse who is using alternative medicine in your nursing practice. You may benefit from this studyby reflecting on caring aspects of your practice that are healing to yourself as well as yourpatients, and by the knowledge that you are contributing to the body of literature in nursing. Noother particular benefits will be gained through participation. There are no risks to you fromparticipation in the study. Finally, no deception such as false claims, alteration of data, pretense,or misrepresentation is involved.

You may withdraw from the study at any time without question or penalty. If you chooseto participate your participation will be completely anonymous and all data collected will be keptconfidential and secured separately from your demographic information. You will be assigned afictitious name of your choosing that will be used on all published reports of the study. The taperecording and its transcripts will be kept in a locked fire proof safe in the researcher's home forperiod of (3) years, after which time they will be destroyed.

If you have any questions about this study, you may contact me by phone at (302-542-1269 or email at dmorr35 187@wildcats.wilmu.edu. Should you have additional questions, myfaculty advisor is Dr. Pamela Curtiss, and her contact information is 302-684-1986, or you maycontact the Wilmington University Committee for the Protection of Human Subjects at thelocations below. The research and this consent form have been approved by the UniversityReview Board, which insures that research involving people follows federal regulations.

Researcher:Denise S. Morris RN, MSNDoctoral StudentEducational Leadership and InnovationWilmington University302-542-1269

Chairpersons of the Wilmington University Committee for the Protection of Human Subjects:Please send questions to (302) 295-1 126 or doctorate @ wilmu.edu or the offices of WilmingtonUniversity Doctor of Education Program, Human Subject Committee at Wilson Graduate Center,31 Reads Way New Castle DE 19720.

89

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I , have read the information provided and have decided toparticipate in this research project. Ms. Morris has answered any questions I have askedabout the research, or my participation in the study. I understand that I may withdraw atany time without prejudice after signing this form. I understand that I will receive a copyof this form as well.

(Signature) (Date)

Appendix D

Guiding Interview Questions

Questions:

All interview questions will be non-leading and open ended to allow forindividual variation (Kvale, 1996). According to Marshall & Rossman (2006) qualitativeinquiry is uniquely suited to uncover the unexpected, and to explore new approaches, andthereby requires flexibility so "that data gathering can respond to increasingly refinedresearch questions" (p. 38). Therefore, a single broad guiding question for the study is:How do Pagan nurses promote healing through the use of spirit based alternative forms ofcaring? Additional questions will be general enough to permit exploration yet focusedenough to delimit the study (Marshall & Rossman, 2006) and will be semi- structuredquestions which can be found in the interview protocol below. Further, the researcherwill utilize probing questions to obtain additional information of the individual'sresponse to these open ended questions.

According to Reissman (1993) "Narrative analysis takes as its object ofinvestigation the story itself." (p.l) Therefore, as story tellers, researchers are affordedthe opportunity to learn from the everyday story and the telling of the story by itsparticipants. Kvale (1996) further confirms that in depth conversation interviewingallows for stories to be co-authored resulting in effect a method to reveal phenomenon.Consequently, storytelling becomes a social and powerful act utilized to empower theparticipants in identifying linkages in their real world.

Interview Protocol

1. What has been your experience with caring and spirituality?2. How do you use Pagan rituals and/or healing modalities in the provision of

nursing caring? Which ones do you use? How do you perceive that thesemodalities affected patient outcomes?

3. How has being Pagan offered you new connections to your roles/lives asnurses?

4. How do you see this connection impacting the future of nursing educationor theory development?

5. How has being Pagan affected your professional relationships? What wasthe reaction from those with whom you worked?

6. What is the impact of Pagan spirituality on the ways in which you providenursing care?

7. Why did you choose this spiritual path to ground your practice of caring?

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