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The clinical governance of the soul: 'deep management' and the self-regulating subject in integrated community mental health teams.

Health professionals have often been described as if they were in conflict with the new managerialist spirit in health care. However, because of their distributed and mobile sites of intervention, the work of community teams presents particular problems for traditional notions of management. In this UK study we identify how mental health team members are regulated by means of a subtle 'deep management'. Team members point to a lack of management direction from senior colleagues, even though some of them participate in the management process themselves. However, the lack of overt management leads them to prioritise clients and foreground professional identities in performing their duties and much additional administrative work besides. This also meant that the organisational structure-the team-was defined in subjective terms. Participants had become self-regulating 'deep managed' subjects under a largely hands-off management regime.

Administrative Personnel↗

Body and soul.

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Attitude of Health Personnel↗

Soul sacrifice.

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Humans↗

Nursing the soul.

Many diseases are recognized to be the result of a changing society and related to nutrition, alcohol, smoking and, not least, stress. What is not overtly recognized is that many of these diseases are the results of a society that alienates people from themselves and each other and biomedicine is demonstrably unable to provide answers to this. Identifying the need for social answers to disease is part of the answer but if healing of people in the true sense of the word is to be achieved, spiritual dimensions of care are fundamentally important and a more healing approach is required which works to promote the body's self healing powers. Nurses have always had a healing role and this is currently being rediscovered. The essential spiritual aspects to this healing role calls for a new philosophy, an approach that needs the support of nurse education and nurse management. The movement towards a more therapeutic approach may be what underpins the current move into complementary therapies by qualified nurses, demonstrating their response to the dominant ideology of distancing and detachment so prevalent in the market economy of health.

Holistic Nursing↗

Rituals: the 'soul' purpose.

Nursing has, perhaps unknowingly, given recognition to the importance of maintaining the client's normal rituals and patterns of day-to-day activity on admission to hospital. To make the client feel more at ease, comfortable and relaxed, care is aimed at adhering to their usual routine. To this end, the client's bedtime rituals, toileting habits and many other of their daily routines are explored during the hospital admission process or initiation ceremony to the ward. As nurses, we place great meaning on trying to maintain these rituals and routines for the client, recognizing that keeping a sense of normality may be of great importance. It seems almost paradoxical then, that it is we nurses who criticize ourselves for compulsively adhering to what are described as ritualistic ways of working; which it has been said, are of seemingly little value both to the client's own healing process and nursing itself. In a recent paper the notion that ritualized practice had no place in nursing and made a case for the defence of rituals was challenged. This paper expands this theme further, exploring the symbolic and ancestral necessity for rituals, drawing upon archetypal psychology to help illustrate the potential hazards for the nursing milieu of dismissing rituals without fully understanding their latent purpose.

Activities of Daily Living↗

The folk psychology of souls.

The present article examines how people's belief in an afterlife, as well as closely related supernatural beliefs, may open an empirical backdoor to our understanding of the evolution of human social cognition. Recent findings and logic from the cognitive sciences contribute to a novel theory of existential psychology, one that is grounded in the tenets of Darwinian natural selection. Many of the predominant questions of existential psychology strike at the heart of cognitive science. They involve: causal attribution (why is mortal behavior represented as being causally related to one's afterlife? how are dead agents envisaged as communicating messages to the living?), moral judgment (why are certain social behaviors, i.e., transgressions, believed to have ultimate repercussions after death or to reap the punishment of disgruntled ancestors?), theory of mind (how can we know what it is "like" to be dead? what social-cognitive strategies do people use to reason about the minds of the dead?), concept acquisition (how does a common-sense dualism interact with a formalized socio-religious indoctrination in childhood? how are supernatural properties of the dead conceptualized by young minds?), and teleological reasoning (why do people so often see their lives as being designed for a purpose that must be accomplished before they perish? how do various life events affect people's interpretation of this purpose?), among others. The central thesis of the present article is that an organized cognitive "system" dedicated to forming illusory representations of (1) psychological immortality, (2) the intelligent design of the self, and (3) the symbolic meaning of natural events evolved in response to the unique selective pressures of the human social environment.

Attitude to Death↗

Collective soul: the spirituality of an interdisciplinary palliative care team.

OBJECTIVE: Although spirituality as it relates to patients is gaining increasing attention, less is known about how health care professionals (HCP) experience spirituality personally or collectively in the workplace. This study explores the collective spirituality of an interdisciplinary palliative care team, by studying how individuals felt about their own spirituality, whether there was a shared sense of a team spirituality, how spirituality related to the care the team provided to patients and whether they felt that they provided spiritual care. METHODS: A qualitative autoethnographic approach was used. The study was conducted in a 10-bed Tertiary Palliative Care Unit (TPCU) in a large acute-care referral hospital and cancer center. Interdisciplinary team members of the TPCU were invited to participate in one-to-one interviews and/or focus groups. Five interviews and three focus groups were conducted with a total of 20 participants. RESULTS: Initially participants struggled to define spirituality. Concepts of spirituality relating to integrity, wholeness, meaning, and personal journeying emerged. For many, spirituality is inherently relational. Others acknowledged transcendence as an element of spirituality. Spirituality was described as being wrapped in caring and often manifests in small daily acts of kindness and of love, embedded within routine acts of caring. Palliative care served as a catalyst for team members' own spiritual journeys. For some participants, palliative care represented a spiritual calling. A collective spirituality stemming from common goals, values, and belonging surfaced. SIGNIFICANCE OF RESULTS: This was the first known study that focused specifically on the exploration of a collective spirituality. The culture of palliative care seems to foster spiritual reflection among health care professionals both as individuals and as a whole. While spirituality was difficult to describe, it was a shared experience often tangibly present in the provision of care on all levels.

Adult↗

The circle of the soul: the role of spirituality in health care.

This paper examines the critical attitude of behavioral professionals toward spiritual phenomena, and the current growing openness toward a scientific study of spirituality and its effects on health. Health care professionals work amidst sickness and suffering, and become immersed in the struggles of suffering persons for meaning and spiritual direction. Biofeedback and neurofeedback training can facilitate relaxation, mental stillness, and the emergence of spiritual experiences. A growing body of empirical studies documents largely positive effects of religious involvement on health. The effects of religion and spirituality on health are diverse, ranging from such tangible and easily understood phenomena as a reduction of health-risk behaviors in church-goers, to more elusive phenomena such as the distant effects of prayer on health and physiology. Psychophysiological methods may prove useful in identifying specific physiological mechanisms mediating such effects. Spirituality is also a dimension in much of complementary and alternative medicine (CAM), and the CAM arena may offer a window of opportunity for biofeedback practice.

Biofeedback, Psychology↗