Introduction

Reflecting on care as the essence of the nursing profession

many times there is, as a critical element, a distancing between the
theoretical aspects and the real world of practice. The aim is to contrast
the theoretical reality with practice and have greater arguments for the
conceptualization of care from lived experiences, both of the
people who are cared for like the caregivers. In the last decade, it has
dedicated a lot of attention to defining and clarifying this concept in the literature of

nursing, demonstrating the place it occupies in health and illness. The

recognition of the different definitions will be a conceptual support for the
nursing professional who will help identify some needs
prioritizing assistance and strengthening care; essence of the profession, it
that will improve people's quality of life.
 Emotional and spiritual support for the patient

Regarding suffering in the healthcare field, we can see that the great
Most of the research focuses on those social and health services in
which becomes more plausible, such as palliative care or
intensive care or oncological. However, when we look beyond the
At the doors of these services, we find people around us who suffer and
that are not addressed in this regard. Due to a lack of professional identity and
disinformation to users about who we are, we observe that
we neglect both our profession and its purpose: the person
vulnerable

This factor must be added to the biomedical paradigm that emphasizes the
biological aspect of the disease, with interventions planned towards it
healing, conceiving the patient as a problem to be solved, forgetting the
psychosocial-spiritual state of the person, leading to dehumanization and,
therefore, in depersonalization.

The illness is not the only time when the nurse must care.
On the contrary, their vocation is to work for health, and this in an integral way. And although

the illness can lead to pain, however, it does not have to generate
suffering in the life of man. Hence the importance of knowing this
phenomenon that happens to man, to every man, so that, being known,
provide global quality care and be nurses, returning to our
essence.

Spiritual Suffering

In their work to standardize, study, and develop nursing diagnoses, not

has stopped contemplating one of the problems that is both so old and so new of
man: suffering. This health issue has labeled him as 'Suffering'
spiritual" (00066), being defined as "Deterioration of the capacity to
experiment and integrate the meaning and purpose of life through connection
with the self, others, art, music, literature, nature, or a power
superior to the self." The causes, as the same association points out, are
very varied, such as death, agony, or pain.5But what is the
Suffering? And why spiritual? Let's try to make a
approach to said terms.

Suffering is an experience common to all humanity, which we cannot

to confuse with pain, being this physical. For Lévinas, "it assumes the fact of being
cornered by life and by being." Cassell defines it as: "The state of discomfort
induced by the threat or loss of integrity or disintegration of the person,
regardless of its cause." It is an experience of limit, both moral and
existential, mental, religious, social or political. It reminds us that we are beings
limited, finite, vulnerable

And in the face of this, man asks himself why this happens to us. It abstracts us, it makes us

interrogate the fundamentals of human existence. According to Aristotle's ethics, the

man lives to be happy. Hence we do not want to suffer. The problem arises in
that man does not choose to suffer, but he endures it. As suffering escapes from
our capacity for freedom, we find it difficult to accept, even to define it.10And still
more, we found another factor, the perception of suffering. In the words of
Benito, "is colored by the interpretation the patient makes of a situation
concrete, based on their biographical history, their beliefs, their values.

Therefore, it is necessary to individualize the case and understand its specific experiences.
Well, suffering depends on priorities, concerns, resources, and
values of the person.

At this point is where we find the link to spirituality.

spirituality is a dimension of man like the biological, psychological or the
social, related to the ability to transcend, summarizing it in three
sense of life, values and beliefs. These develop in life.
corporal, psychological, and social, closely united. And like the other three spheres
of man, this also presents certain needs. In this regard, Jomain
define spiritual needs as: "Needs of people,
believers or not, in search of spiritual growth, of a truth
essential, of a hope, of the meaning of life and death, or that are
still wishing to convey a message at the end of life.

The problem with these needs is the difficulty in recognizing and detecting them.
The socio-health professionals, due to lack of tools and due to
disinformation regarding health implications, they cannot delve into it
inside the people they are in charge of, only identifying the
visible needs. They cannot delve into the subjectivity of people.
In such a way that the results obtained are lower and do not achieve the
desired well-being.

Weil establishes the following spiritual needs: the very hunger for order,
of freedom, of obedience, of responsibility, of equality, of hierarchy, of honor,
of punishment, of freedom of opinion, of security, of risk, of truth, of
private property and collective property.17To these needs, Torralba
broadens with the following: need for meaning, for reconciliation, for feeling
forgiven, of prayer, symbolic ritual, of solitude and silence, and of gratuity.

When they are not covered, man suffers, with manifestations depending on the situation.
through the connection with the self, with others, with art, music, literature and the
nature, or with a power greater than the self. For example, one can
to manifest through anger, the expression of alienation, lack of interest in the
nature or expression of despair.

But, for spiritual suffering to occur, memory and

imagination. Memory, since it reminds us of painful experiences that
they could happen to us again and, in turn, fostered by our fantasy,
maximizing and worsening its negative effects. Consequently, man
expresses sadness.

The first effect of sadness is the overwhelming of the spirit and the lack of desire. If our

will, which is our engine, is sick from sadness, our energies are
have a negative influence on the activity. And when we refer to the activity, we do not
we refer not only to physics, but also to cognitive intellect. Thus,
Spiritual suffering influences the rest of the spheres of man.19To this
Regarding this, Koenig has demonstrated the positive effects of spirituality on the
health, Luecken et al. Demonstrated its effects on blood pressure
favoring adaptation to stress, and its benefits have even been demonstrated
in the immune system.

And if sadness reaches high levels, it transforms into despair.

It is the lack of all confidence for the future, a deficiency of all hope. In the face of this,

Man has the capacity for hope, strength, and perseverance.

This does not mean that man should suppress suffering, but that by
through these virtues, man can coexist with him, learning from him,
growing with him. If man is much more than a part of his being, in this
In case of suffering, it means that their being is greater, that they can attain the Good.
even if I am perceiving an evil. Evil occurs because man is, because
It exists, on the contrary. Therefore, man is more than evil. Hence his
ability to place oneself before it. It has more good than bad, so it still
It can be perfected even if a part prevents it.

The key lies in making sense. However, prior to making sense we find
it making sense. If the object towards which I freely and responsibly move myself
I am preparing to reach makes no sense, I do not project it. And giving meaning to life.
It makes sense since it is possible. To do this, it is necessary to integrate all of life into the

person, including adversities and death. It consists of seeking projects,

paths, more than finding a goal. Frankl said: "There is sufficient evidence of
that everything can be taken away from man except one thing: the last of the
human freedoms - the choice of personal attitude towards a set of
circumstances - to decide your own path.

With this we introduce a concept, the healthy sick person, living healthily the
disease. It seems at first a contradiction, but it is through the
acceptance of one’s own illness when healing is approaching.
With this, the patient integrates the illness or their suffering, and from there,
start to give a positive value to the situation. In such a way that spirituality
becomes a tool for effective coping in life
man in his relationship with himself, with others, with the environment and with a being
superior for the meaning and sense it gives to its concrete existence, empowering it
for its self-control.

A requirement to make sense of suffering, and thereby heal it, is patience.

This virtue helps the being vulnerable to face suffering with hope,
giving it meaning, for it still maintains its innermost being, that is, it maintains its
free personality, as it does not let itself be dragged down by the evil that afflicts it with sadness.

Thus, we see that with patience we can give meaning to hope.

suffering. We say in hope, because hope is another of the virtues
that motivate our patience, giving meaning to our life. It is an attitude
an emotional state by which man trusts in a certain future project that
it requires a continuous wait according to your expectations. As Alarcos says, "the
confident hope of the concrete, can only be called in a broad sense
hope

In the face of suffering, a person can live by attacking the objective causes to
to solve them and return to the previous state of equilibrium, or alternatively, another way is the one that

refers to Scheler, "to prevent the suffering of all possible evils from within,
eliminating resistance in the most perfect and voluntary way possible
involuntary and automatic

Care for Spiritual Suffering

This is the essence of Nursing, in caring, although it participates in

to heal. Caring is a way of being, a way of behaving with man. Not
consists only of a set of techniques that are carried out on another person,
it is a way of being towards the other. This way of being certainly involves the
need for some theoretical and technical knowledge, but above all, these two
levels are integrated into the being. The nursing being leads the professional to know and to

to do, it is the vocation of care that moves the professional to delve into their
skills to provide excellent quality care for the other being
human care promotes, prevents or restores the bio-psycho-social balance
spiritual.

And if man cannot live without meaning, Nursing as an expert in care,

one cannot forget the spiritual dimension of man through his being, knowing and
to know how to provide holistic care, through which it takes care of the
being in its entirety from its interpersonality. Theories such as those of Watson, Ray or
Kolcaba contemplates this dimension of man considering the person as
more than the sum of its parts, a whole, since spirituality
promotes our resilience or coping and enhances our quality of life.

Nursing in spiritual care has a great role, helping the patient

to identify the values and beliefs that give meaning to human beings, especially
to the patient who is in the most vulnerable moment. This way, it will be able to favor
the coping with pain or suffering by identifying the emotions. But the
Lack of time and training in the helping relationship prevents providing care.
spirituals that are required.
 Conclusions

The hospitalization process generates emotional disturbances whose

feelings vary both in form and intensity. The
lack of knowledge of the clinical picture, the routine imposed by the hospital, the
distancing from family members, from the residence and from their belongings, in addition to

the uncertainty regarding the treatment and the expectations generated by

the treatment and the hospital discharge are some of the reasons for changes in the
emotional area.

In this context, patients lack emotional support so that

they can express their fears, anxieties, and expectations regarding the
hospitalization process. However, considering the characteristics
institutional bodies of the place where the study was developed, the support
emotional constitutes a challenge that demands modifications in the
management paradigms, in such a way that enables the implementation of care
integral.

It stands out as a limitation that the study was

developed in a unit that serves only patients of the
Single Health System, which may have favored the evaluation
positive feedback from patients regarding emotional support, once the
most come from the Municipal Emergency Service, which,
unfortunately, it is lacking in physical and human resources to
offer care in an appropriate and humanized manner.
 Recommendations

The team caring for a person should take their beliefs into account.
and spiritual needs.

In the absence of appropriate evidence on what is the best way to

provide spiritual support, it is recommended to offer such support as
an integral part of care, regardless of the context of attention, and
with an approach based on the principles of effective communication.

It is important to consider the cultural differences regarding the

spirituality, without it justifying the lack of attention to these aspects in
people belonging to cultural groups different from ours.
 Web bibliography

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