The title Religion, Religious Ethics, and Nursing may conjure expectations for a “world religions” approach to the subject matter of this book. Readers may thus be startled to find that this work contains no charts about what Catholics, Protestants, Jews, and Buddhists believe—the stuff of “introduction to nursing” textbooks. The intent of this book is, instead, to lay the foundation for a deeper exploration of religion and religious ethics as they intersect with nursing theory, education, research, and practice. This work is intended for the classroom, clinicians, and nurse researchers and nurse ethicists who require a theoretical basis for a consideration of religious diversity, religious ethics, religious social ethics, and nursing. While this book points toward practice, it is not a practice-oriented guide. That task is left to the companion volume Religion: A Clinical Guide for Nurses (2012, Springer Publishing Company) written by our colleague Elizabeth Johnston Taylor. So what might the reader encounter in this book?
The first section examines theoretical questions. Chapter 1, “Religion and Nursing,” explores nursing’s neglect of religion in the light of the deep religious faith of Florence Nightingale and her desire for nursing education to be non-sectarian, and in the light of the secularization of society. This chapter also tackles the perspective that religion is a Western construct, a Western invention, that does not reflect the reality of the non-Western world. The chapter concludes with a discussion of how religion is defined.
Chapter 2, “Religious Ethics, Religious Social Ethics, and Nursing,” begins with a series of caveats in the study, understanding, and exercise of religion. These caveats then inform a discussion of four sources of religiousmoral authority that religious traditions and their followers utilize in moral analysis and decision making: sacred writings and sacred stories, tradition, reason, and religious experience. While religions are concerned for the inner life or the spiritual journey, they are also concerned for the shape of the world, with issues of justice and peace. The chapter concludes with an examination of religious social ethics and its involvement in “repairing the world.”
Some clarification must be offered at this point. It is customary in religious studies circles to number years as BCE (Before the Common Era) and CE (in the Common Era) instead of the Christian designations BC and AD. That practice has been adopted in this book. As a further note, we have chosen to retain some technical or specialized religious terminology commonly found in theological or religious works so that the reader may become acquainted with the more common terms used in religious studies and theology. Additionally, it is common in religious literature written within and for its faith community to employ several devotional conventions. For example, in some Jewish texts, “God” is spelled “G-d,” omitting the “o” so as to show reverence for the divine name. In Islam, “peace be upon him” or “PBUH” is written after the name of the Prophet. These are devotional conventions used within the community and are not customarily used in a broader academic literature outside of the community of faith it represents.
Chapter 3, “Religion and Theoretical Thinking in Nursing,” discusses how religion has influenced nursing’s theoretical thinking and addresses some of the ethical implications of the use of religious ideas in a diverse society. It begins with a brief discussion of the influences of religion on early nursing theory, including nursing models, meta-paradigm development, and nursing diagnosis. It then discusses current trends in religion and spirituality in the broader social context and their influence on nursing theory. The ethical issues of proposing theoretical views in nursing that do not adequately encompass the religious views of patients are then outlined. The chapter concludes with a proposed approach to incorporating religion into nursing theoretical thinking that allows for both the diverse experience of religious individuals and the scientific basis of the nursing discipline.
Chapter 4, “Feminist and Religious Ethics in Nursing,” explores the complex relationships between nursing, religion, and feminism with particular emphasis on ethics. Although nursing has strong and continuing roots in institutional religion, feminist critiques of institutional religion have profoundly influenced the construction of religion in current nursing discourse. This chapter will illustrate some of the contributions that feminist ethics can make to religious ethics in nursing and reveal how each provides a lens to understanding what is good and right to do within the discipline. Following the lead of feminist developments in the sociology of religion, this chapter will propose a broader vision for the contributions of feminist ethics to religion and religious ethics in nursing.
Chapter 5, “A Critical Reading Across Religion and Spirituality: Contributions of Postcolonial Theory to Nursing Ethics,” provides an overview of postcolonial theory as one form of critical inquiry particularly salient for the study of religion and spirituality, and highlights several methodological and practice implications for nursing ethics. The chapter examines the contributions of postcolonial theory, arguing that critical perspectives offer invaluable analytic tools in the critical analysis of religion, spirituality, and health/nursing. In so doing, it urges a re-thinking of nursing’s typical de-emphasis of creedal religions in the quest for a universal spiritual experience.
Chapter 6, “Intersectional Analyses of Religion, Culture, Ethics, and Nursing,” asserts that in the presence of unprecedented global migration and societal diversity, religion and spirituality need to be understood as intertwined with other social categories such as gender, ethnicity, and class. Referred to as intersectionality, these interrelationships shape how identities are lived out and how social disadvantage and oppression operate in collective ways. The intersectionality of religion/spirituality with other social classifications has, as the chapter suggests, not been adequately accounted for in the fields of nursing and nursing ethics. At the level of social ethics, religion/spirituality are implicated in the intersecting social determinants of health and health inequities. In the realm of clinical nursing ethics, a lens of intersectionality gives insight into the complexities of moral agency, ethical decision making, and relational practice.
The succeeding section on historical research on religious nursing provides two examples of research by nurse-historians. This section is intended to show the promise that such historical research holds for understanding both nursing and religious nursing, how religion has influenced the development of nursing, and how religious nursing has influenced both nursing and health care worldwide. These two chapters constitute an implicit call for additional historical research internationally.
The third section of the book includes seven religious-tradition specific chapters on Hinduism, Judaism, Christianity, Islam, Sikhism, Religions of Native Peoples, and emergent non-religious spiritualities, sometimes termed New Age spiritualities. The intent of these chapters is not to provide an “essentials” approach or overview of the beliefs of the tradition, nor to examine the health-related implications of certain religious prescriptions and proscriptions. Rather, the aim of these chapters is to explore how these traditions conceptualize various concepts that are pivotal to nursing, including health, well-being, compassion, nursing, care of the stranger, or community. While the impulse might be to start with the particulars of what a religious tradition says about, for example, diet or infertility or family structure, knowing this will not assist the nurse to actually understand what lies behind these norms. Understanding what a tradition means by health and concepts more central to health provides a stronger foundation for nurses to engage with religious patients, and may broaden nursing’s understanding of its own theory and practice. Additional religious traditions are utilized as examples throughout the text. The limited number of traditions that we examine in greater depth serves as an implicit invitation to nursing to research the religion-nursing intersections of other traditions as well.
The two chapters of the fourth section, “Religion and Nursing Practice,” review the research on religion and provide illustrative clinical vignettes pertaining both to patients and to nurses who are religious. Chapter 16, “Religion and Patient Care,” explores how patient or family religious beliefs and practices affect responses to illness challenges and health care. After considering how religion may be associated with health, the chapter illustrates how religiosity colors the interpretation of illness and health behaviors. Because the existent empirical evidence provides considerable insight into how religious coping influences response to illness and how religion has an impact on health care decision making, these areas are examined as well. The chapter reviews not only the impact of these religious beliefs, but also the interplay of religious practices and health, and the religious care that patients want and get. The chapter concludes by identifying implications this evidence provides for clinical nursing practice.
Chapter 17 reviews the literature that suggests the ways in which the religiosity of nurses influences their practice of nursing. It explores ways in which personal religiosity may or may not be appropriately brought to the bedside, and directly addresses the ethical issue of proselytizing in the clinical setting.
The 18th chapter, “The Measurement of Religious Concepts in Nursing,” is specifically intended for the nurse researcher or consumer of nursing research. It addresses problems in the measurement of religious concepts for nursing theory and practice based on individuals’ self-reports, including the concepts of religious affiliation, religious attendance (participation in religious services or activities), religious orientation, private religiousness, religious coping, and religious beliefs, values, and experiences. The results of studies that answer these questions vary and must be interpreted in light of the characteristics of the measurement instruments that were used and the populations and purposes for which they were developed. This chapter explores the processes and assumptions underlying the measurement validation of religious concepts and the corresponding inferences that may be warranted.
The book concludes with a brief epilogue, “Looking Back and Looking Ahead: A Concluding Postscript.” The intent of this brief section is to draw together both the problems and promise that an exploration of religion by nursing might hold. It takes a critical look backward, and an anticipatory look forward to where nursing might go in its study of religion, religious ethics, and nursing theory and practice.
This work is, then, anything but a world-religions approach to religions and nursing. It is our hope that its readers will find it provocative, challenging, and enriching and that it will spur further interest in a topic that has, to nursing’s disadvantage, lain fallow.
Marsha D. Fowler
Easter 2011
6th day of Passover 5771
4th day of Chol Hamoed 5771