Caring and Nurse

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^. isConnie 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
Chapter
I. Introduction
Statement of the Problem
Purpose of the Study
Need for the Study
Healthcare System Change
Culture Change
Nursing Change
Research Question
Definition of Terms
!Literature
Review
Bookmark not defined.
Error!
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.
V.
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
Discussion
Summary of Findings
64
Limitations/Generalizability
70
Implications
71
Recommendations for Further Research
73
viii
References
Appendix A Human Subjects Review Committee Approval

..Error! Bookmark not defined.
Appendix B Advertisements
Appendix C Informed
Consent
not defined.
Error! Bookmark
Appendix D Guiding Interview

Questions
IX
Chapter I
Introduction
To effectively interpret the truly great role that has been assigned her, neither a
liberal education nor a high degree of technical skill will suffice. The nurse must also be
master 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 "IThou" 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
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:
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
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
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
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.
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.
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
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-spiritemotion) 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 afew 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 and
witches 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 nursepatient 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, & Alemn, 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 reestablishing 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 wayif 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
40
most comfortable in those environments. I get answers from the elementis 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."
41
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 longterm 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
44
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 physicalwell you knowwe 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
47
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 gloryit 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
48
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 77patient 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 collgial 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,
50
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.
51
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,
52
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
53
"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.
55
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
56
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
57
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.
61
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
63
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 of Findings
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
64
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
67
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.

Recommendations for 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 collgial 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
WILMINGTON UNIVERSITY
HUMAN 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 Chair
or Representative
/-/><L M- /Ar*^X
Print name
Signature
HSRC Chair
Or Representative
?? ', , , /
Date: _1____1_
.,
M>tJutLPrint5.name
IgMfWfi
Signature
Date: __l___/_
87
Page 1 of 1
Human Participant Protections Education for Research Teams
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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 Teams
online course, sponsored by the National Institutes ofHealth (NIH), on 02/22/2008.
This course included the following:
key historical events and current issues that impact guidelines and legislation on
human participant protection in research.
ethical principles and guidelines that should assist in resolving the ethical issues
inherent in the conduct ofresearch with human participants.
the use ofkey ethical principles and federal regulations to protect human participants
at various stages in the research process.
a description ofguidelines for the protection of special populations in research.
a definition of informed consent and components necessary for a valid consent.

a description ofthe role of the IRB in the research process.
the roles, responsibilities, and interactions offederal agencies, institutions, and

researchers in conducting research with human participants.
National Institutes of Health
http://wwvv.nih.gov
Home I Contact Us | Poiicies | Accessibility | S_i.te.He.lp | Site Map

A Service of the National Cancer Institute
t_k!
http://cme.cancer.gov/cgi-biri/cms/cts-cert5.pl
'FlKSTt .' ?
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 approaches
of complementary and alternative spirituality thereby promoting healing utilizing

the power of the spirit. Increased understanding of caring can be used to design
strategies and curriculum approaches that are more therapeutic for patients and
empowering for nurses
Confidentiality: Your identity will be kept strictly confidential!!! and you will be
assigned a pseudonym of your choosing. Further, all data sources will be maintained in a
locked safe until the completion of the study, after which time they will be destroyed.
This study is for my doctoral dissertation and offers additional protection
through the Human Subjects Review Committee of Wilmington University in compliance
with all Federal guidelines.
Participants: Nurses that have been practicing Pagans and use complementary and
alternative 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, MSN
If 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 interviewing

nurses about their perceptions and experiences with caring. I hope to understand information that
can be utilized in designing nursing curriculum that embraces complementary and alternative
techniques that are therapeutic for patients, and satisfying for nurses.
Participation in this study is strictly voluntary. If you choose to participate in the
interview, I will ask you a question about your perceptions regarding caring and spirituality. This
interview will last approximately 1 hour. These interviews will be audiotape recorded to ensure
accurate documentation of your responses.
You have been invited to participate because you have identified yourself as a Pagan
nurse who is using alternative medicine in your nursing practice. You may benefit from this study
by reflecting on caring aspects of your practice that are healing to yourself as well as your
patients, and by the knowledge that you are contributing to the body of literature in nursing. No
other particular benefits will be gained through participation. There are no risks to you from
participation 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 choose
to participate your participation will be completely anonymous and all data collected will be kept
confidential and secured separately from your demographic information. You will be assigned a
fictitious name of your choosing that will be used on all published reports of the study. The tape
recording and its transcripts will be kept in a locked fire proof safe in the researcher's home for
period 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 (302-5421269 or email at dmorr35 187@wildcats.wilmu.edu. Should you have additional questions, my
faculty advisor is Dr. Pamela Curtiss, and her contact information is 302-684-1986, or you may
contact the Wilmington University Committee for the Protection of Human Subjects at the
locations below. The research and this consent form have been approved by the University
Review Board, which insures that research involving people follows federal regulations.
Researcher:
Denise S. Morris RN, MSN

Doctoral Student
Educational Leadership and Innovation

Wilmington University
302-542-1269
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 Wilmington
University Doctor of Education Program, Human Subject Committee at Wilson Graduate Center,
31 Reads Way New Castle DE 19720.

89
90
I
, have read the information provided and have decided to
participate in this research project. Ms. Morris has answered any questions I have asked
about the research, or my participation in the study. I understand that I may withdraw at
any time without prejudice after signing this form. I understand that I will receive a copy
of this form as well.
(Signature)
(Date)
Appendix D
Guiding Interview Questions
Questions:
All interview questions will be non-leading and open ended to allow for
individual variation (Kvale, 1996). According to Marshall & Rossman (2006) qualitative
inquiry is uniquely suited to uncover the unexpected, and to explore new approaches, and
thereby requires flexibility so "that data gathering can respond to increasingly refined
research 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 of
caring? Additional questions will be general enough to permit exploration yet focused
enough to delimit the study (Marshall & Rossman, 2006) and will be semi- structured
questions which can be found in the interview protocol below. Further, the researcher
will utilize probing questions to obtain additional information of the individual's
response to these open ended questions.
According to Reissman (1993) "Narrative analysis takes as its object of
investigation the story itself." (p.l) Therefore, as story tellers, 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 effect a method to reveal phenomenon.
Consequently, storytelling becomes a social and powerful act utilized to empower the
participants 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 these
modalities affected patient outcomes?
3. How has being Pagan offered you new connections to your roles/lives as
nurses?
4. How do you see this connection impacting the future of nursing education
or theory development?
5. How has being Pagan affected your professional relationships? What was
the reaction from those with whom you worked?
6. What is the impact of Pagan spirituality on the ways in which you provide
nursing care?
7. Why did you choose this spiritual path to ground your practice of caring?
91

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Nursing: A Story of the Spirituality in Caring

A dissertation submitted to the faculty of

Innovation and Leadership

UMI Number: 3425046

All rights reserved

Copyright 2010 by ProQuest LLC.

All rights reserved. This edition of the work is protected against

789 East Eisenhower Parkway

Ann Arbor, Ml 48106-1346

Nursing: A Story of Spirituality in Caring

Signed: {jTJ^. & M fh. ( /aZ^^

Signed: .^W^. isConnie W. Kieffer Ed.D., Member of the Dissertation Committee

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

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

Error! Bookmark not defined.

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Statement of the Problem

Purpose of the Study

Need for the Study

Healthcare System Change

History and Evolution of Nursing Role

Connections of Caring with the Spirit

Bookmark not defined.

Data Collection Procedures

.Error! Bookmark not defined.

Grounded Spiritually Unified Beings

Blurred Ethical Lines

Absence in Nursing Curriculum

.Error! Bookmark not defined.

Recommendations for Further Research

.Error! Bookmark not defined.

Appendix A Human Subjects Review Committee Approval

Appendix D Guiding Interview

Error! Bookmark not defined.

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

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

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

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

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

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

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

Purpose of the Study

Cultural change. Public expectations of individualized spiritual holistic care are

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

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

The single broad research question for this study is:

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

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

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

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

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

History and Evolution of the Nursing Role

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

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

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

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

Once again our understanding of terms further complicates our expressions of

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

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

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

1 . Humanistic altruistic system of values

4. Helping-trusting, human care relationship

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