Alas and alack Humpty was quite right. It is the second part of the comment, which reads, ‘The question is,’ said Alice, ‘whether you can make words mean different things.’‘The question is,’ said Humpty Dumpty, ‘which is to be master–that's all.’

Words do mean what we want them to mean. Recent use on the BBC of the word ‘amount’ to denote number is a current example: e.g. a greater amount of people are using Heathrow than at any time in the past.

If words do mean what we intend them to mean, or perhaps more accurately what those who have influence intend them to mean, then is it not the case that the word ‘spiritual’ is an invented term? As I understand it, the etymology of the word spirit is from air or breath, the air or breath which ‘inspired’ the first life that breathed oxygen and the expiration of which indicates the end of what we call life.

I think Dr Bash is quite right in his contention that using the word spirituality in the context of nursing may not be the best way of conveying what we might expect of nurses and what they might expect of themselves. It seems to me that what they do admirably is to understand the need in the mind of the patient for compassionate understanding of their predicament in which the patient both requires and is uncertain about requiring certainty about his or her condition and support in that confused state.

The nurse probably ‘knows’ more of the implications of the diagnosis or condition than the patient. The nurse also knows that he or she knows this. The nurse also probably knows from long experience that there is an ambivalence on the part of the patient regarding what he or she wants to know. A more useful way of addressing the needs of patients would surely be training in trying to understand and respond to the range of demands in the mind of the patient when confronted with the helplessness, which comes with ill health. Questions one might ask a nurse to ask of herself are:

What do I know about the patient's condition?

What do I think the patient understands about her/his condition?

How much of the information I have would it be sensible/beneficial to share with the patient?

If I share what I know what effect is this likely to have on the patient depending on their cultural/religious/spiritual background?

The nurse cannot know about the cultural/religious background of the patient except insofar as (s)he shares the same tradition.

Spirituality depends to a large extent on cultural/religious background. It follows that the nurse can only show a generalized attitude to the patient, which I would characterize as scientifically or medically informed compassion. For me, compassion is a manifestation of the sympathy most humans have access to. One of the most outstanding characteristics of Jesus Christ was his compassion, He defined spirit as wind coming and going we knew not whence (John 3:8). This compassion allows him to deal with the woman in Samaria who says ‘even the dogs under the table can eat the children's crumbs,’ (Mark 7:28). He accepts her rebuke and convinces her of his authenticity, by being aware of her needs, and she becomes one of his first missionaries. Surely informed compassion is what is needed in nurses, perhaps in all of us, and talk of such abstractions as spirituality is not helpful.