Beyond belief…
Redefining spirituality By Jonathan Smith, PhD, MA, and Simon Robinson, PhD, MA, BA, Dip Counseling, Dip Soc SAdmin, Cert Theol
M
any claim that the social care system in the United Kingdom is in crisis. With more people living longer, the demand for care services increases year after year. Some people say that the system has been severely underfunded for many years and we’re now witnessing the devastating effect of this ever-growing funding gap. For example, one report claims that, in real terms, spending on social care has fallen by around £770 million (roughly $1.2 billion) since 2010.1 Another report, which includes a survey of general practitioners, revealed that one in five had seen patients harmed as a result of “delays or a lack of support” from mental health services, while shortfalls had forced 82% of physicians to act “outside of their competence.”2 This substantial debate concerning the crisis in care has raised many different responses, from a focus on the meaning of care and how it relates to the practice of nursing or medication, through compliance and how one ensures standards of care and protects the patient, to poor-quality leadership at board, middle, and line levels.3,4 Some of the most interesting and contentious proposals on how to deal with this crisis relate to the issue of spirituality. For example, a study in Nursing Standard ends with the proposal that spirituality provides the answer to this crisis in care: “Here we want to get across the message that spirituality is the key to minimizing the profession’s long history of patient abuse and neglect.”5
44 February 2015 • Nursing Management
Universal issues
www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.nursingmanagement.com
Nursing Management • February 2015 45
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Beyond belief…Redefining spirituality There seems to be no doubt that there has been a crisis around the funding practice and, indeed, the meaning of care in the health service. What seems less clear, however, is whether spirituality does, in fact, provide the answer. This article explores the dilemmas and proposes a more suitable way forward.
The meaning of spirituality It’s been suggested that nursing staff members don’t actually know what the term spirituality means, and very few practice it as part of their care.6 This may be because spirituality has been marginalized in the face of
Many writers on spirituality refer to psychological and spiritual needs as if the differences are obvious. This raises questions about the meaning of spirituality. If, for instance, we can distinguish mind, body, and spirit, is this asserting a dualistic view of the nonphysical spirit? If not, then is spirituality the same as holism? One researcher suggests that the term psychological is quite sufficient—in terms of need for significant relationships, for meaning, and so on. Fifth, it’s suggested that qualitative empirical work can easily lead to an uncritical approach to the data. All
We argue that spirituality does have something to offer healthcare managers, particularly in relation to quality of care, employee engagement, and the manager’s own meaning, but only with a far more robust focus. other elements of care. Alternatively, it may be because the term itself is problematic.7-9 First, as the argument goes, the concept of spirituality isn’t clear. There are many different uses of it, with different criteria for determining what’s “correct.” Second, the term derives from religion and is still associated with it. Although many writers may intend to take a broad approach and begin with a generic definition, they soon revert to a religious definition, and often a Christian and Western-centric interpretation at that.8 Third, it’s argued that the term “spirit” is vague and not open to empirical verification. Fourth, it isn’t clear whether the reported empirical work actually points to something termed spirituality as distinct from psychology.
that such data can point to is sets of beliefs that are held by practitioners. The data doesn’t support particular views of spirituality or a domain that’s distinct from psychology. Also, those writing about spirituality often attempt to assert particular, often narrow, narratives. This suggests turf wars or attempts to reclaim the religious roots of care. In so doing, there’s little attention paid to the different narratives of care, or the different interpretations of spirituality. Finally, there seems to be a lack of practice-centered research about the application of spirituality and spiritual assessment, or how spirituality might be practiced and applied by healthcare leaders. All this suggests that spirituality can’t simply be touted as the
46 February 2015 • Nursing Management
answer to the crisis of care. If the argument has any power, it seems to come from the assumed association of spirituality with care. But even this association has problems. Feminist and pastoral writers question simplistic views of altruism, arguing that this takes away from the idea of a community of mutual care.10 At the very least, a more critical analysis of spirituality, and care itself, is needed before the two are taken to be synonymous.
Is it outdated? The crisis of care has, of course, given rise to some critical analysis, most of which gets by without any reference to spirituality. Among these are the Chief Nursing Officer for England’s six Cs and the Mid Staffordshire NHS Foundation Trust Public Inquiry, or the Francis reports.3,11 The six Cs, based around six values, are care, compassion, courage, communication, competence, and commitment. These six Cs focus on professional care, and intriguingly attempt to make a conceptual distinction between care and compassion. However, the concept of care isn’t straightforward, suggesting that the six Cs are really a work in progress requiring more discussion.12 The Francis reports are fundamentally about the governance and leadership of caring institutions, and move the debate into the practice of responsibility and accountability and how these relate to care.11 They also raise questions relating to failures in regulation and what care compliance might look like. If we have to police care, and protect patients, then this seems to change the very meaning of care. It begins to look as if care itself is as vague a concept as spirituality. Perhaps the answer is a conceptual segue into the concept of intelligent kindness, which some Healthcare www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Beyond belief…Redefining spirituality Trusts in the United Kingdom are exploring, not least because this seems like a simpler concept that can be applied by managers.13 This debate around kindness has encouraged healthcare managers and professionals to wrestle more rigorously with the issues of care. The focus here on a person-centered holistic perspective, with intellectual and emotional intelligence as part of the mix, is striking. However, the concept of intelligent kindness doesn’t get to the root of the meaning of care and, thus, of where the imperative of kindness actually comes from and
A more robust focus We argue that spirituality does have something to offer healthcare managers, particularly in relation to quality of care, employee engagement, and the manager’s own meaning, but only with a far more robust focus. Elsewhere, we argue that spirituality isn’t about asserting a particular set of meanings, but rather about meaning itself.12 It’s the meaning of our lives that constitutes our sense of value, worth, and purpose. At the organizational level, it’s focused on what the organization is about, what its larger purpose (the
The debate around kindness has encouraged healthcare managers and professionals to wrestle more rigorously with the issues of care. how this connects theory, value, and practice. It could be argued that kindness (with the emphasis on kin) isn’t inclusive enough. So, have we left spirituality behind; have we moved beyond belief? Surprisingly, no. It seems that healthcare leaders don’t want to let go of spirituality. Is this because spirituality might have something to offer them; something to offer to the well-being of the patient, not just on deathbeds but well before? This focus on spirituality is evidenced by the fact that some Healthcare Trusts in the United Kingdom are developing spirituality strategies to try to specify what it all means, and how it might be applied by managers. Several have included a section on spiritual assessment in their assessment frameworks.
basis of its perceived worth) is, and what provides the call for people to work there and do the best work of their lives. Meaning is context dependent; isn’t something that can simply be enforced from above; and requires effective reflection and dialog to know, communicate, and understand what we and others mean, and to know why this offers a sense of value and of being valued in a particular context. It’s precisely at moments of crisis when these things might become most important for service users, staff members, leaders, and organizations. This means that spirituality for the service users, staff members, and managers is about helping them connect all of the meanings about their value and relationships. Far from imposing meaning, this
48 February 2015 • Nursing Management
involves dialog and the freedom to find, question, develop, or affirm meaning and value. This is about respecting and nurturing the agency of the service user and staff member, and is more than being kind or respecting their freedom of choice. Clearly the professional caregiver can’t enable this when he or she feels disempowered, devalued, and fearful, or without genuinely caring about the patient. Spirituality would then involve exploration of meaning and value in practice.
An expanded view There may well be something very significant about this focus on spirituality as a way of helping to address the crisis in care, something that goes to the heart of the issues. However, in order for spirituality to be more fully embraced, we argue that expanded views of spirituality and care are needed, focused not just on the care profession but also on the leadership and governance of healthcare. This expanded view of spirituality has to be embedded as a central aspect to leadership and governance, summed up in the cocharismatic views of leadership.9 However, this doesn’t mean leadership focused on the charisma or special qualities of the individual leader. Charisma originates from the Greek word for gift or grace. This emphasizes the relational nature of charisma, as both shared throughout the community and dependent on mutual relationships within the community. The charismata are in effect virtues to be practiced in the community by all members. We argue, therefore, for a view of leadership that moves us away from the focus on a special or elite individual, and the traits that mark them out, to leadership that enables virtues, informed by the ongoing narrative of and dialog in the community, to be practiced in the community and beyond. www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
These virtues enable the owning of responsibility for ideas, values, and practice, something central to leadership, nursing, and care. Through the practice of responsibility, everyone in the organization becomes a leader in some way and is then likely to feel more empowered. The task of the authorized leader is to enable this empowerment. This view of spirituality is summed up under seven, slightly different, Cs: 1. Consciousness of the other. 2. Connectivity, which appreciates relationships with the other. 3. Criticality, which involves an appreciative testing of difference. This is key to a spirituality that’s appropriate for the contemporary healthcare environment, working against the dominance of a single narrative. 4. Commitment to person, purpose, and project. 5. Community, which provides the context and is key to identity, relationships, trust, and meaning. 6. Character, which focuses on the virtues that are both strengthened by spirituality and also strengthen spirituality. Their practice enables responsible action, including responsible leadership. 7. Creativity. This focuses on character and community, and moves away from the realm of utility and tools to ontology and existentialist concerns. In this respect, practice and action are further embodiments of meaning, focused on the negotiation of shared responsibility and the creation of value that moves beyond the individual and the organization, and helps people feel recognized and valued. This reminds us that spirituality is as much physical and relational as it is about concepts or feelings. At the heart of this view of spirituality is responsibility and dialog. The first of these focuses on agency and accountability—knowing what I’m doing and talking about, and www.nursingmanagement.com
the capacity to give an account of meaning and practice both in the community and beyond. The second means that everything is open to question. The culture at County Hospital (previously known as Mid Staffs) was one that feared questions and was motivated by fear, and so allowed meaning and practice to be focused simply on targets. The danger with many of the compliance solutions to County Hospital currently being proposed is that these targets and the associated fear will simply be reasserted in different ways, maintaining feelings of disempowerment and of being devalued. Leadership and governance is rather about rolemodeling and enabling shared meaning and value to be developed, and with that the confidence to articulate and practice care.
21st century spirituality Researchers may well be right in asserting that spirituality does have an important role to play in addressing the crisis in care.5 We argue that in order for this to be effective, it needs an expanded view of spirituality, which is at the very heart of leadership, governance, nursing, and care. The new spirituality should focus on the cocharismatic views of leadership, meaning and practice, and dialog and responsibility to empower others so a crisis can be navigated effectively, giving us all something we can believe in. NM REFERENCES 1. Health and Social Care Information Centre. Personal social services: expenditure and unit costs, England, 2012–13, provisional release. http://www.hscic.gov.uk/searchca talogue?productid=12389&topics=1%2fS ocial+care%2fSocial+care+expenditure&so rt=Relevance&size=10&page=1#top. 2. Department of Health. Attitudes to Mental Illness research report. Time to change. http:// www.time-to-change.org.uk/research-reportspublications/public-attitudes-mental-illness.
3. Department of Health. Government launches new vision for NHS nursing care. http://webarchive.nationalarchives.gov. uk/20130402150017/http://cno.dh.gov. uk/2012/12/04/vision-nursing/. 4. CIPD. Employee outlook focus on culture change and patient care in the NHS. http://www.cipd.co.uk/binaries/6333%20 Culture%20change%20NHS%20SR%20 (WEB).pdf. 5. Wright S, Neuberger J. Why spirituality is essential for nurses. Nurs Stand. 2012; 26(40):19-21. 6. Johnson C. Ongoing research into spiritual assessment. Leeds Metropolitan University. 2013. 7. Paley J. Spirituality and nursing: a reductionist approach. Nurs Philos. 2008;9(1): 3-18. 8. Crust L. Challenging the myth of a spiritual dimension in sport. Athletic Insight—Online Journal of Sport Psychology. 2006;8(2): 17-31. 9. Bouckaert L, Zsolnai L, eds. The Palgrave Handbook of Spirituality and Business. Basingstoke: Palgrave Macmillan; 2011. 10. Neal J, ed. Handbook of Faith and Spirituality in the Workplace. London: Springer; 2013. 11. Robinson S, Smith JA. Co-Charismatic Leadership: Critical perspectives on Spirituality, Ethics and Leadership. Oxford: Peter Lang; 2014. 12. Robinson S. Spirituality, Ethics and Care. London: Jessica Kingsley; 2008. 13. Robert Francis QC. Francis Report 2013: The Mid Staffordshire NHS Foundation Trust Public Inquiry. http://www.midstaffs publicinquiry.com/report. 14. McCance TV, McKenna HP, Boore JR. Caring: dealing with a difficult concept. Int J Nurs Stud. 1997;34(4):241-248. 15. Ballatt J, Campling P. Intelligent Kindness: Reforming the Culture of Healthcare. London: Royal College of Psychiatrists; 2011. Jonathan Smith is the Leadership Development manager at Devon and Cornwall Police in the United Kingdom, and previously a senior lecturer at the Lord Ashcroft International Business School at Anglia Ruskin University in Cambridge, United Kingdom. Simon Robinson is a professor of Applied Professional Ethics at Leeds Beckett University in Leeds, United Kingdom. The authors have disclosed that they have no financial relationships related to this article. DOI-10.1097/01.NUMA.0000460036.71438.f1
Nursing Management • February 2015 49
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Redefining spirituality By Jonathan Smith, PhD, MA, and Simon Robinson, PhD, MA, BA, Dip Counseling, Dip Soc SAdmin, Cert Theol
M
any claim that the social care system in the United Kingdom is in crisis. With more people living longer, the demand for care services increases year after year. Some people say that the system has been severely underfunded for many years and we’re now witnessing the devastating effect of this ever-growing funding gap. For example, one report claims that, in real terms, spending on social care has fallen by around £770 million (roughly $1.2 billion) since 2010.1 Another report, which includes a survey of general practitioners, revealed that one in five had seen patients harmed as a result of “delays or a lack of support” from mental health services, while shortfalls had forced 82% of physicians to act “outside of their competence.”2 This substantial debate concerning the crisis in care has raised many different responses, from a focus on the meaning of care and how it relates to the practice of nursing or medication, through compliance and how one ensures standards of care and protects the patient, to poor-quality leadership at board, middle, and line levels.3,4 Some of the most interesting and contentious proposals on how to deal with this crisis relate to the issue of spirituality. For example, a study in Nursing Standard ends with the proposal that spirituality provides the answer to this crisis in care: “Here we want to get across the message that spirituality is the key to minimizing the profession’s long history of patient abuse and neglect.”5
44 February 2015 • Nursing Management
Universal issues
www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.nursingmanagement.com
Nursing Management • February 2015 45
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Beyond belief…Redefining spirituality There seems to be no doubt that there has been a crisis around the funding practice and, indeed, the meaning of care in the health service. What seems less clear, however, is whether spirituality does, in fact, provide the answer. This article explores the dilemmas and proposes a more suitable way forward.
The meaning of spirituality It’s been suggested that nursing staff members don’t actually know what the term spirituality means, and very few practice it as part of their care.6 This may be because spirituality has been marginalized in the face of
Many writers on spirituality refer to psychological and spiritual needs as if the differences are obvious. This raises questions about the meaning of spirituality. If, for instance, we can distinguish mind, body, and spirit, is this asserting a dualistic view of the nonphysical spirit? If not, then is spirituality the same as holism? One researcher suggests that the term psychological is quite sufficient—in terms of need for significant relationships, for meaning, and so on. Fifth, it’s suggested that qualitative empirical work can easily lead to an uncritical approach to the data. All
We argue that spirituality does have something to offer healthcare managers, particularly in relation to quality of care, employee engagement, and the manager’s own meaning, but only with a far more robust focus. other elements of care. Alternatively, it may be because the term itself is problematic.7-9 First, as the argument goes, the concept of spirituality isn’t clear. There are many different uses of it, with different criteria for determining what’s “correct.” Second, the term derives from religion and is still associated with it. Although many writers may intend to take a broad approach and begin with a generic definition, they soon revert to a religious definition, and often a Christian and Western-centric interpretation at that.8 Third, it’s argued that the term “spirit” is vague and not open to empirical verification. Fourth, it isn’t clear whether the reported empirical work actually points to something termed spirituality as distinct from psychology.
that such data can point to is sets of beliefs that are held by practitioners. The data doesn’t support particular views of spirituality or a domain that’s distinct from psychology. Also, those writing about spirituality often attempt to assert particular, often narrow, narratives. This suggests turf wars or attempts to reclaim the religious roots of care. In so doing, there’s little attention paid to the different narratives of care, or the different interpretations of spirituality. Finally, there seems to be a lack of practice-centered research about the application of spirituality and spiritual assessment, or how spirituality might be practiced and applied by healthcare leaders. All this suggests that spirituality can’t simply be touted as the
46 February 2015 • Nursing Management
answer to the crisis of care. If the argument has any power, it seems to come from the assumed association of spirituality with care. But even this association has problems. Feminist and pastoral writers question simplistic views of altruism, arguing that this takes away from the idea of a community of mutual care.10 At the very least, a more critical analysis of spirituality, and care itself, is needed before the two are taken to be synonymous.
Is it outdated? The crisis of care has, of course, given rise to some critical analysis, most of which gets by without any reference to spirituality. Among these are the Chief Nursing Officer for England’s six Cs and the Mid Staffordshire NHS Foundation Trust Public Inquiry, or the Francis reports.3,11 The six Cs, based around six values, are care, compassion, courage, communication, competence, and commitment. These six Cs focus on professional care, and intriguingly attempt to make a conceptual distinction between care and compassion. However, the concept of care isn’t straightforward, suggesting that the six Cs are really a work in progress requiring more discussion.12 The Francis reports are fundamentally about the governance and leadership of caring institutions, and move the debate into the practice of responsibility and accountability and how these relate to care.11 They also raise questions relating to failures in regulation and what care compliance might look like. If we have to police care, and protect patients, then this seems to change the very meaning of care. It begins to look as if care itself is as vague a concept as spirituality. Perhaps the answer is a conceptual segue into the concept of intelligent kindness, which some Healthcare www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Beyond belief…Redefining spirituality Trusts in the United Kingdom are exploring, not least because this seems like a simpler concept that can be applied by managers.13 This debate around kindness has encouraged healthcare managers and professionals to wrestle more rigorously with the issues of care. The focus here on a person-centered holistic perspective, with intellectual and emotional intelligence as part of the mix, is striking. However, the concept of intelligent kindness doesn’t get to the root of the meaning of care and, thus, of where the imperative of kindness actually comes from and
A more robust focus We argue that spirituality does have something to offer healthcare managers, particularly in relation to quality of care, employee engagement, and the manager’s own meaning, but only with a far more robust focus. Elsewhere, we argue that spirituality isn’t about asserting a particular set of meanings, but rather about meaning itself.12 It’s the meaning of our lives that constitutes our sense of value, worth, and purpose. At the organizational level, it’s focused on what the organization is about, what its larger purpose (the
The debate around kindness has encouraged healthcare managers and professionals to wrestle more rigorously with the issues of care. how this connects theory, value, and practice. It could be argued that kindness (with the emphasis on kin) isn’t inclusive enough. So, have we left spirituality behind; have we moved beyond belief? Surprisingly, no. It seems that healthcare leaders don’t want to let go of spirituality. Is this because spirituality might have something to offer them; something to offer to the well-being of the patient, not just on deathbeds but well before? This focus on spirituality is evidenced by the fact that some Healthcare Trusts in the United Kingdom are developing spirituality strategies to try to specify what it all means, and how it might be applied by managers. Several have included a section on spiritual assessment in their assessment frameworks.
basis of its perceived worth) is, and what provides the call for people to work there and do the best work of their lives. Meaning is context dependent; isn’t something that can simply be enforced from above; and requires effective reflection and dialog to know, communicate, and understand what we and others mean, and to know why this offers a sense of value and of being valued in a particular context. It’s precisely at moments of crisis when these things might become most important for service users, staff members, leaders, and organizations. This means that spirituality for the service users, staff members, and managers is about helping them connect all of the meanings about their value and relationships. Far from imposing meaning, this
48 February 2015 • Nursing Management
involves dialog and the freedom to find, question, develop, or affirm meaning and value. This is about respecting and nurturing the agency of the service user and staff member, and is more than being kind or respecting their freedom of choice. Clearly the professional caregiver can’t enable this when he or she feels disempowered, devalued, and fearful, or without genuinely caring about the patient. Spirituality would then involve exploration of meaning and value in practice.
An expanded view There may well be something very significant about this focus on spirituality as a way of helping to address the crisis in care, something that goes to the heart of the issues. However, in order for spirituality to be more fully embraced, we argue that expanded views of spirituality and care are needed, focused not just on the care profession but also on the leadership and governance of healthcare. This expanded view of spirituality has to be embedded as a central aspect to leadership and governance, summed up in the cocharismatic views of leadership.9 However, this doesn’t mean leadership focused on the charisma or special qualities of the individual leader. Charisma originates from the Greek word for gift or grace. This emphasizes the relational nature of charisma, as both shared throughout the community and dependent on mutual relationships within the community. The charismata are in effect virtues to be practiced in the community by all members. We argue, therefore, for a view of leadership that moves us away from the focus on a special or elite individual, and the traits that mark them out, to leadership that enables virtues, informed by the ongoing narrative of and dialog in the community, to be practiced in the community and beyond. www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
These virtues enable the owning of responsibility for ideas, values, and practice, something central to leadership, nursing, and care. Through the practice of responsibility, everyone in the organization becomes a leader in some way and is then likely to feel more empowered. The task of the authorized leader is to enable this empowerment. This view of spirituality is summed up under seven, slightly different, Cs: 1. Consciousness of the other. 2. Connectivity, which appreciates relationships with the other. 3. Criticality, which involves an appreciative testing of difference. This is key to a spirituality that’s appropriate for the contemporary healthcare environment, working against the dominance of a single narrative. 4. Commitment to person, purpose, and project. 5. Community, which provides the context and is key to identity, relationships, trust, and meaning. 6. Character, which focuses on the virtues that are both strengthened by spirituality and also strengthen spirituality. Their practice enables responsible action, including responsible leadership. 7. Creativity. This focuses on character and community, and moves away from the realm of utility and tools to ontology and existentialist concerns. In this respect, practice and action are further embodiments of meaning, focused on the negotiation of shared responsibility and the creation of value that moves beyond the individual and the organization, and helps people feel recognized and valued. This reminds us that spirituality is as much physical and relational as it is about concepts or feelings. At the heart of this view of spirituality is responsibility and dialog. The first of these focuses on agency and accountability—knowing what I’m doing and talking about, and www.nursingmanagement.com
the capacity to give an account of meaning and practice both in the community and beyond. The second means that everything is open to question. The culture at County Hospital (previously known as Mid Staffs) was one that feared questions and was motivated by fear, and so allowed meaning and practice to be focused simply on targets. The danger with many of the compliance solutions to County Hospital currently being proposed is that these targets and the associated fear will simply be reasserted in different ways, maintaining feelings of disempowerment and of being devalued. Leadership and governance is rather about rolemodeling and enabling shared meaning and value to be developed, and with that the confidence to articulate and practice care.
21st century spirituality Researchers may well be right in asserting that spirituality does have an important role to play in addressing the crisis in care.5 We argue that in order for this to be effective, it needs an expanded view of spirituality, which is at the very heart of leadership, governance, nursing, and care. The new spirituality should focus on the cocharismatic views of leadership, meaning and practice, and dialog and responsibility to empower others so a crisis can be navigated effectively, giving us all something we can believe in. NM REFERENCES 1. Health and Social Care Information Centre. Personal social services: expenditure and unit costs, England, 2012–13, provisional release. http://www.hscic.gov.uk/searchca talogue?productid=12389&topics=1%2fS ocial+care%2fSocial+care+expenditure&so rt=Relevance&size=10&page=1#top. 2. Department of Health. Attitudes to Mental Illness research report. Time to change. http:// www.time-to-change.org.uk/research-reportspublications/public-attitudes-mental-illness.
3. Department of Health. Government launches new vision for NHS nursing care. http://webarchive.nationalarchives.gov. uk/20130402150017/http://cno.dh.gov. uk/2012/12/04/vision-nursing/. 4. CIPD. Employee outlook focus on culture change and patient care in the NHS. http://www.cipd.co.uk/binaries/6333%20 Culture%20change%20NHS%20SR%20 (WEB).pdf. 5. Wright S, Neuberger J. Why spirituality is essential for nurses. Nurs Stand. 2012; 26(40):19-21. 6. Johnson C. Ongoing research into spiritual assessment. Leeds Metropolitan University. 2013. 7. Paley J. Spirituality and nursing: a reductionist approach. Nurs Philos. 2008;9(1): 3-18. 8. Crust L. Challenging the myth of a spiritual dimension in sport. Athletic Insight—Online Journal of Sport Psychology. 2006;8(2): 17-31. 9. Bouckaert L, Zsolnai L, eds. The Palgrave Handbook of Spirituality and Business. Basingstoke: Palgrave Macmillan; 2011. 10. Neal J, ed. Handbook of Faith and Spirituality in the Workplace. London: Springer; 2013. 11. Robinson S, Smith JA. Co-Charismatic Leadership: Critical perspectives on Spirituality, Ethics and Leadership. Oxford: Peter Lang; 2014. 12. Robinson S. Spirituality, Ethics and Care. London: Jessica Kingsley; 2008. 13. Robert Francis QC. Francis Report 2013: The Mid Staffordshire NHS Foundation Trust Public Inquiry. http://www.midstaffs publicinquiry.com/report. 14. McCance TV, McKenna HP, Boore JR. Caring: dealing with a difficult concept. Int J Nurs Stud. 1997;34(4):241-248. 15. Ballatt J, Campling P. Intelligent Kindness: Reforming the Culture of Healthcare. London: Royal College of Psychiatrists; 2011. Jonathan Smith is the Leadership Development manager at Devon and Cornwall Police in the United Kingdom, and previously a senior lecturer at the Lord Ashcroft International Business School at Anglia Ruskin University in Cambridge, United Kingdom. Simon Robinson is a professor of Applied Professional Ethics at Leeds Beckett University in Leeds, United Kingdom. The authors have disclosed that they have no financial relationships related to this article. DOI-10.1097/01.NUMA.0000460036.71438.f1
Nursing Management • February 2015 49
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
