COVID-19 pandemic, ethics, evidence-based practice, faith community nursing, nursing



  1. Hellman, Ann N.


ABSTRACT: In the face of a public health emergency, nurses, particularly those serving faith communities, need to understand and live out their roles in adhering to evidence-based practice while demonstrating grace and obedience to Scripture. Serving as public health role models and advocates, nurses in faith communities can inform and support church leaders in following government directives for the common good. Applicable Scripture, ethical, and research considerations are presented.


Article Content

Almost weekly, we have been confronted with news stories informing the public about the latest COVID-19 outbreak originating from large gatherings, including meetings of faith communities. Such stories particularly highlight congregations which are not practicing the recommended COVID-19 safety precautions such as social distancing, encouraging the wearing of masks, restricting congregational meals, or altering their way of participating in communal sacraments. These stories are closely followed by other news articles detailing pastors and church leaders facing fines and possible arrest due to their intentions to disobey local governmental restrictions prohibiting mass gatherings for worship (Burke, 2020). As the pandemic shows no signs of abating in the near future, such issues will continue to arise, possibly even worsen.

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Outbreaks of new infectious viruses and COVID-19 variants seem to be constantly on the horizon. Therefore, the discussions surrounding the topic with COVID-19 may arise again in the future regarding other disease outbreaks. As Christian nurses, we can find ourselves caught between the stances of pure science and faith. Because our professional education is grounded in science, the practices of maintaining safety recommendations such as frequent handwashing, mask wearing, social distancing, and minimizing travel should not only be expected from us but also practiced as role models for the public. As Christians, we are instructed to place our trust in God's protection, provision, and his supreme will. However, to some in the faith community, this trust is demonstrated by avoiding the practice of government safety regulations regarding COVID-19. As people bridging both worlds, we must ask, "Are these two stances polar opposites of each other or can we adhere to both?"


This is a difficult place in which to find oneself. From personal experience, I have been confronted repeatedly with the concept that church members who insist on wearing masks and social distancing are relying more on science and acting from fear rather than relying on faith and the protection of God. As Christian nurses, where do we stand in this argument? What is our role in helping to navigate these issues from the public health safety perspective while also supporting religious allegiance and freedoms? Our ideal response to such situations would be one that is ethical and responsible to our profession to support public health guidelines while demonstrating adherence to God's teachings and providing a faith-filled testimony.



As Christians, our first point of information and guidance should always come from Scripture. The Bible provides numerous examples of the importance of adhering to principles of good hygiene and sanitation, striving for good nutrition, obtaining adequate rest, seeking medical care, and even submitting to quarantine and practicing social distancing. God presented the Israelites with specific instructions on hygiene practices and sanitation in the Old Testament books of Leviticus, Numbers, and Deuteronomy. We must remember that the crux of these instructions was to promote health and prevent disease transmission. God devoted a significant amount of instructional time to these issues, so we must ask ourselves if we, as nurses, should spend any less time promoting these concepts.


In Leviticus 13, God instructed his followers to seek medical care for diagnosis with the priests who functioned in that culture as health experts. Also, in Leviticus 13, God provided the template for quarantining those who were ill with contagious diseases, separating them from people who were healthy. With such extensive instruction regarding prevention of disease transmission, if we are not taking the recommended infectious disease precautions in our congregations, are we dishonoring God? Because God instructed the Israelites to follow these guidelines, does that mean the Israelites lacked faith in God's provision and protection? Perhaps a reminder of these Scripture passages would be a beneficial place to begin explaining your viewpoint to others.


Other Scripture sections provide some explanatory guidelines pertaining to submitting to the authorities. Although being mindful that our sovereign God places and removes earthly kings at his will (Daniel 2:21), we read in 1 Peter 2:13-17 of God's instruction to submit to the governing authorities:


Therefore, submit yourselves to every ordinance of man for the Lord's sake, whether to the king as supreme, or to governors, as to those who are sent by him for the punishment of evildoers and for the praise of those who do good. For this is the will of God, that by doing good you may put to silence the ignorance of foolish men-as free, yet not using liberty as a cloak for vice, but as bondservants of God. Honor all people. Love the brotherhood. Fear God. Honor the king. (NKJV)


Although we are instructed to submit to the governing authorities, we also are provided limitations of such submission. When Peter and the apostles were instructed by religious leaders to stop teaching about Jesus, the apostles replied, "We ought to obey God rather than men" (Acts 5:29, NKJV). This directive is certainly applicable in circumstances in which the government is attempting to prevent the worship of God or the teaching or following of his precepts. However, this is not the case with the government recommendations and regulations during the current pandemic. The government has limited the gathering of large crowds of people participating in a myriad of activities, not specifically targeting the gathering of churches. Therefore, as the government is not directing its actions against choice of religion or expression of worship, but rather the public safety hazards presented by such large gatherings, as Christians we should follow the direction of the government. In this, we demonstrate both the proper behavior of responsible citizens and the ethical adherence expected of our profession. Furthermore, modern social media has allowed most churches to continue to meet and offer worship services online (i.e., Facebook, YouTube) while facilitating one-to-one communication through messaging and "chatting" to all or individual attendees during a live online service.



Reviewing the American Nurses' Association (ANA) Code of Ethicsfor Nurses with Interpretive Statements (2015), many of the provisions convince nurses to advocate for safety practices within their individual faith congregations as an ethical obligation. The ANA Code (2015) defines a patient as "individual, family, group, community, or population" and speaks of the nurse's commitment to the patient. These provisions state the nurse promotes and advocates for the health and safety of the patient; the nurse possesses the authority, accountability, and responsibility for nursing practice; the nurse makes decisions and takes actions consistent with the obligation to promote health and to provide optimal care; and the nurse owes the same duties to self as to others, including the responsibility to promote health and safety. Clearly, we have a distinct responsibility for the safety of those around us, as all people are potential patients.


In analyzing the relationship between nursing practice and conceptualizations of the common good, Jairath et al. (2006) wrote, "In the evidence-based environment, the actions of health care professionals, including nurses, are driven by the best available evidence. Knowledge emanates from data, whether acquired through research or analysis of clinical results" (p. 62). As science- and evidence-based professionals, nurses work for the common good when they adhere to evidence-based practice.


An American Association of Critical-Care Nurses' (AACN) position statement (2020) strongly promotes the role of science related to clinical practice and public health policy:


* Use evidence-based practice, a problem-solving approach that involves the conscientious use of current best evidence, in making decisions about patient care.


* Be aware of conflicts of interest-professional, financial, or political-when evaluating data and evidence.


* Correct false healthcare information at every opportunity among your peers, your neighbors, or your loved ones. The general public may lack your expertise in evaluating evidence.


* Be ardent defenders of evidence-based science and respect for expert knowledge, especially when these are attacked for commercial or political gain.


* Speak out against censorship of scientific ideas or the silencing of legitimate experts who provide advice for the betterment of public health. (para 7)



The AACN advocates for healthcare professionals to make all healthcare decisions-for individuals and for the population-from the basis of the best scientific evidence available. "All individuals have a responsibility to seek truth and reject misinformation or propaganda, especially those in leadership positions" (AACN, 2020, para 4).


In a 2020 position paper titled Duties of Christian Health Care Professionals in the Face of a Pandemic Infection, the Christian Medical and Dental Associations affirmed that healthcare workers have invested themselves in a covenantal, rather than contractual, model of professionalism. Inherent in this covenant, "for the public good to be achieved and our patients to receive the best care possible, health care providers and institutions should work as closely and reciprocally as we can to achieve solidarity of purpose toward the common good" (p. 4).


The Health Ministries Association (HMA, 2021) issued a statement encouraging faith community nurses (FCNs) to answer the call to serve their communities during COVID-19. This includes teaching and role modeling COVID-19 safety guidelines and praying with and coordinating care for those who need support. Providing FCN services related to COVID-19 falls within the scope of FCN practice to educate, advocate, and coordinate healthcare services with the larger healthcare community (ANA & HMA, 2017).



Where does this leave us as Christian nurses in this age of the pandemic and with future disease outbreaks? While experiencing the difficulty of our position, this situation provides exceptional opportunities, particularly in the areas of leadership and role modeling. "Leadership in times of uncertainty such as a disaster requires intentional acts of role modeling. The presence and action of the leader become magnified" (Caroselli, 2020, p. 170; Sidebar).


Another area of opportunity for nurses during a pandemic includes that of healthcare expert. Lynette Vehrs, Washington State Nurses Association President, promotes nurses fulfilling the expert role for public education, and proposes that nurses, as sources of expertise, participate in media training to better prepare themselves for that responsibility (Moore, 2020).


Further, the role of communicating publicly includes verifying the truth and correcting misinformation.


When erroneous or misleading statements are made in or by the media, we should be the first to object and to correct. We should resist politicization of scientific data or recommendations because our loyalty belongs to Jesus. We can offer the public a calming, fact-based, truth-focused voice in a sea of anxiety-provoking news. (Ko, 2021, para 19)


Ko, who formerly served with the Centers for Disease Control and Prevention (CDC), states (2021) that, along with providing correct and current information to the public, healthcare professionals have "a unique opportunity to partner with pastors and leaders of other community organizations who are ill-equipped to assess the torrent of medical data that follows a pandemic" (para 17) helping to assess risk, create realistic plans, and persuade communities to engage in behavior that protects the most vulnerable.


Nurses can become catalysts to ensure congregations are acting as responsible citizens by advocating safe and healthy practices; encouraging adherence to recommended infectious disease precautions; educating fellow Christian brothers and sisters regarding infectious diseases including scientific facts, precautions, transmission, and latest treatments; demonstrating that one's actions are based in the faithful practices of holding to the instruction of Scripture and for the love of fellow man; and honoring the ethical standards of our profession.


Furthermore, when church congregations implement recommended precautions, they not only avoid conflict with government regulations, but also highlight the brotherly love for which all congregations should be known. Nurses need to help people understand how to wear masks correctly, how to effectively wash hands or use hand sanitizer with 60% or higher alcohol concentration, how to clean surfaces, and how to successfully practice social distancing. Although these are highly discussed recommendations, those without infectious disease knowledge or understanding of contact precautions often do now know wise use of safety precautions.


Nurses in faith communities can provide critical information regarding COVID-19, helping to dispel false information as well as offering up-to-date accurate, evidence-based facts.


Nurses may rest assured their actions are supported not only by the ethical code of our profession but also by the Bible. Of particular application to our current pandemic and the status of our nation are Scriptures encouraging us to show love to all (John 13:34-35; Romans 12:10; Galatians 5:14; Galatians 6:2, 10; Ephesians 4:32; Philippians 2:4; 1 Peter 1:22; 1 Peter 3:8; 1 John 4:7). By extending love to those around us, we will be characterized as "God's chosen ones, holy and beloved," displaying "compassionate hearts, kindness, humility, meekness, and patience" Colossians 3:12 (ESV). For if we instruct in the spirit of love, our words will be better received and we will be stronger advocates for the health and safety of our congregations and our communities.



Nurses stand in the unique position of responding in love, demonstrating allegiance to God, and caring for their brothers and sisters in Christ. Such behavior displays commitment to the principles of public safety while serving their communities, which includes faith congregations. Through these actions, we will be living according to God's plan for Christ followers. Offering the best and most accurate health information to help people make evidence-informed decisions for their health is the best way nurses can serve their faith communities.


SIDEBAR: A Christian Nurse's COVID Response

The COVID-19 pandemic has brought unprecedented challenges to both the healthcare system and communities of faith. Although some assume that science and faith are in opposition to one another, nurses of the Christian faith are uniquely qualified to understand science as a gift from God that can be used to serve God, love God's people, and help to bring about the work of healing. When science and faith appear to collide, how can Christian nurses respond?



I am a nurse practitioner and the chief operating officer of an urban nonprofit clinic, and I see patients with COVID-19 most days of the week. I also serve on my church's COVID Task Force. My faith has never been more important to my work as a source of resiliency and hope. My work has never more essential in living my belief that God loves creation deeply. In this country alone, we have seen more than 744,000 people lose their lives to COVID-19 (CDC, 2021, October 31).


Severe racial disparities persist, with black Americans dying of COVID-19 at 2.5 times the rate of white Americans (The COVID Tracking Project, 2020). This grieves the heart of God and should grieve the church as well. Yet, I watch Christians argue that keeping churches closed and wearing masks is giving in to fear. My N95 is my lifeline right now, so how do I respond?



First, Christian nurses have a unique perspective on fear. Fear protects us, helping us identify situations that could harm us. As nurses, we have delivered terrible diagnoses to patients and seen fear in their eyes. We have prayed with families who have watched their loved ones enter surgery, wondering if they'll see them again. We know this fear is real.


For me, I am not acting in fear when I put on a mask and turn down social events; I am acting in fear when I work as if God is not sovereign. Faith does not invalidate fear but provides a path by which we can act despite it. We can trust that God is with us and use the tools and knowledge of our profession to protect our patients. Christian nurses can help frame the discussion around fear, focusing on a vision of caring for God's creation using the most current knowledge of COVID-19 transmission.



Christian nurses also can help guide their faith communities in safely meeting the needs of congregants. The work of the church is essential right now, from providing social support, comfort in times of loss, meeting the physical needs of members experiencing hardships, and providing tools for coping, meditation, and prayer. At the same time, even prior to the COVID-19 pandemic, churches have been sources of significant communicable disease outbreaks (Zepeda-Lopez et al., 2010). Nurses can evaluate data on regional COVID-19 cases and risk factors within their church bodies and assist church leadership in developing structures to safely continue the work of the church. Just as the work of the church is not defined by the physical walls of the church, the work of nurses does not start and end inside the clinic or hospital.



Finally, as Christian nurses we can model rest. As the pandemic stretches on with no end in sight, resting in God's provision and strength is essential to continuing our work in a way that is compassionate, centered, and safe. Nurses, along with other healthcare professionals, must establish limits and create space for self-healing. We must trust that the work of saving lives and healing bodies is not ours alone. We can bear this together as communities and as a nation as we draw strength from God and one another.


-Breanna Lathrop, DNP, MPH, FNP-BC, is chief operations officer at Good Samaritan Health Center in Atlanta, Georgia.


Web Resources


* American Hospital Association


* American Nurses Association COVID-19 Resource Center


* Centers for Disease Control and Prevention COVID-19


* Centers for Medicare & Medicaid Services


* Faith Community Nurse Network


* Health Ministries Association


* Federal Emergency Management Administration (FEMA)




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