Editorial: Time as presence and opportunity: the key to spiritual care in contemporary nursing practice.

Spirituality as an emerging area of academic study within health care has experienced rapid development over a 20year period with mounting evidence that spiritual support yields improvements in a variety of physical and psychological health outcomes (Koenig 2012). The scientific development in the field of health sciences and its ethical and moral foundations leave no space for doubt with regard to nurses’ duty to assess patients’ spiritual needs. A holistic provision of care based on a scientific clinical reasoning, which comprises the assessment of spiritual needs, the nursing diagnosis, the planning of effective interventions and the evaluation of positive health outcomes is increasingly expected of nurses (Caldeira et al. 2013). However, at the same time the notion of meaning making is gaining popularity as the central component of spirituality (Caldeira et al. 2013), gaining consensus on definitions of spirituality within the literature from a research perspective has proved challenging (Koenig 2012). Notwithstanding these debates, providing spiritual care in clinical practice attracts less dissension and is more straightforward (Koenig 2012). It is primarily based on practical care and application by directly addressing clients’ individual spiritual needs, by supporting meaning-making, connections and transcendence, alleviating suffering and providing a sense of wellbeing that may help clients deal with adversity (Weathers et al. 2015). Even so, despite a belief among most nurses that providing spiritual care to patients is important and part of their role (McSherry & Jamieson 2011), there are a great deal of barriers in the clinical environment that impede spiritual care delivery. It can be difficult to provide spiritual care due to a lack of training, lack of objectivity of the concept of ‘spiritual care’, uncertainty about the role and lack of time (McSherry & Jamieson 2011). While a lack of education and understanding are clearly practical barriers to enacting spiritual care practices, we find it curious that time presents itself as a barrier to the provision of this essential care. We suggest that re-examining the understandings of time and nurse behaviours within time spaces might legitimately contribute to more meaningful and effective care. Conversely, if time is used as a reason not to provide spiritual care then this is something that will likely be detrimental to both the profession and to the clients in our care. It is true that nursing interventions require time, and time is a critical factor in the management of clinical practice, taking particular relevance when it comes to prioritising tasks. However, what is of concern is that when nurses perceive not having time to provide the care they consider they should, the most frequent nursing care left undone are comfort and support of clients (Ausserhofer et al. 2014). As such, when nurses perceive they lack time they tend to become more concerned with routines and tasks. Curiously, while the amount of time required for the intervention of ‘spiritual support’ by nurses is recommended as 16–30 minutes, according to the Nursing Interventions Classification (NIC), and the intervention ‘facilitating spiritual growth’ takes longer, 31– 45 minutes (Bulechek et al. 2013), simply being in the moment with a client can also facilitate spiritual care delivery (RCN 2011). Spiritual care turns into reality in a space between two verbs or two conditions: do/doing and be/being. Although time is important for the management of care, this is a time counted in units, numerically, rhythmic and quantitatively. It is this clock watching and measuring of time that causes a lack of attention to how time can be used in a more meaningful way. On the one hand, time is a basic resource for quality of care and for the organisation of the nursing teamwork, and on the other hand, there is a challenge towards transforming the clock-time into a substance time or meaningful time. Counting time, chronologically, refers to the order of time, within specific time periods (Stevenson 2015). However, it is of interest to note that unlike English there are two ancient Greek words for time still in use today, Kr onos and Kair os. While Kr onos refers to chronological or sequential time, Kair os refers to time as having a more qualitative and significant element. Kair os ‘is variously described in relation to a temporality and to a way of acting: it is the opportune moment’ (Sloane 2006). It is a ‘propitious moment for decision or action’ an ‘opportunity’ (Stevenson 2015). Thus, it is useful for nurses to consider time as an opportunity where meaningful things can happen, rather than something to be counted. Time use can be made more efficient but also more dignified, by giving more thought and substance to available time. This is the key: caring in a different way. Spiritual care is not about interventions counted in time, but about how meaningful those interventions are for clients. Using time effectively means being able to see more than just look, and being able to listen more than just hear. These attributes require communicational, human and ethical skills without which nursing care is just a checklist of delivered tasks. Indeed in an RCN report on members’ views (n = 4054) on spirituality, 89 9% of respondents confirmed the most fre-