Ray (1989) points out the different demands for care that APNs have to face today: the major areas (political and economic) dominate over the other ones (educational, social, ethical, etc.). Since nurses have to focus on these dimensions, their interactions also change and cannot take spiritual care into consideration. According to Ray (1989), humanistic dimensions are rarely addressed, although patients need this type of care. Workforce shortage forces nurses to provide more services that are administered by economic dimension. Nurses cannot provide spiritual-ethical care because their services are limited by budget, insurance systems, as well as political factors.
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