A discussion paper about 'meaning' in the nursing literature on spirituality: an interpretation of meaning as "ultimate concern" using the work of Paul Tillich.

Spirituality is often explained in the nursing literature as the patient's quest to find meaning in life and in their experiences. This is most often described in an unlimited and unconditional way defined by whatever interpretations the person places upon it. This opens it to a variety of understandings, some of which may be negative and unhelpful in terms of what we usually consider to be spiritual well being. This discussion paper attempts to look beyond the generality of this idea to examine whether our concept of having meaning, if used in terms of spirituality, should be conditional on meanings which are actually to do with the depth of our being and not meanings which only give pleasure and satisfaction. The paper attempts to do this in two ways. First it explores the beliefs of Victor Frankl to ask the question whether having meaning alone is sufficient to provide spiritual comfort or whether the content of the particular beliefs associated with meaning, may matter. Frankl is often used as a source for the idea of spirituality being to do with meaning and in this paper Frankl's thought is explored in detail to see his own underlying beliefs which helped in his life experiences. Secondly, an understanding of 'meaning' as being conditioned by something "ultimate" described by Paul Tillich is explored. This would give nursing a more structured and purposeful approach to using the term 'meaning' in relation to spiritual care and in addition it would open up a way forward in terms of researching which particular meanings might be most helpful in illness and adversity.