nursing, nursing education, prayer, spiritual care, spiritual competency



  1. Keesee, Lea
  2. Nease, Sandy
  3. Gallegos, Belinda


ABSTRACT: Educating prelicensure nurses about the positive outcomes of prayer can improve the potential for nurses to develop their skill and readiness to pray with or for patients as is appropriate and ethical. When nursing students learn to pray with their patients and families, the trusting component of the nurse-patient relationship becomes strengthened. As faculty and preceptors role-model praying with patients, students can begin to develop competency in providing spiritual care.


Article Content

Instilling prayer as a culturally and spiritually competent intervention for the prelicensure nurse is a vital part of students' foundation. Students who learn to pray with patients develop trust that enhances the nurse-patient relationship. As faculty and preceptors instruct and model praying with patients, students can begin to cultivate this spiritual care competency as well as understand ethical boundaries of prayer in the clinical setting.

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The current state of prayer as a culturally and spiritually competent intervention is a contentious and complex topic. Beliefs, data, and media reports regarding prayer with patients span a continuum between the patient's best interests and what is detrimental for the nurse. According to Swihart et al. (2021) and The Joint Commission (Minton et al., 2016), culturally competent healthcare providers meet and accommodate the cultural, social, and religious needs of patients and their families. The Joint Commission holds hospitals responsible for spiritual assessments, including prayer (Minton et al., 2016), yet spiritual care is described as infrequently occurring (Taylor et al., 2019). The nurse must acknowledge and address the patient's spirituality when deciding if prayer is appropriate (Schoonover-Shoffner, 2013). This commitment is unique to each nurse and encompasses perceptions of character and duty as a person and a healthcare provider. When nurses have the ability, resources, and encouragement to provide spiritual care, patients' and nurses' experiences can be satisfying (Taylor et al., 2019) and yield inner peace (Deal & Grassley, 2012). According to Southard (2020), nurses should be spiritual support leaders at the point of care. Nurses who provided spiritual care reported less burnout (Connerton & Moe, 2018) compared with those who reported being frustrated when they were unable to support spiritually distressed patients (Deal & Grassley, 2012).


Spiritual conversations between patients and nurses positively impact the quality of patient care and can benefit families (Wittenberg et al., 2017). A patient's spiritual needs may be met through prayer (nurse-led, patient-led, or silent), reading a prayer or selected Scripture, being present with the patient, making a pastoral referral, or a combination of spiritual interventions (Deal, 2011). Nurses also can ensure the provision of a safe environment, allowing for understanding, respect, and trust (Isaac et al., 2016).


Green (2018) shared examples of her lived experiences of how praying with patients at their request brought peace and comfort. Patients have reported prayer as a validating intervention that promotes trust and acceptance, consequently improving the nurse-patient relationship (Green, 2018). McMillan and Taylor (2018) sought to comprehend the patient's views regarding clinicians praying with them. Quantitative data from 78 patient-completed questionnaires were analyzed using univariate and bivariate statistical analysis, revealing 88% accepted prayer when offered, 85% found prayer helpful, and 51% wanted prayer daily. McMillan and Taylor's conclusion is encouraging: Patients who want prayer prefer kindness, respect, and warmth from their care providers more than shared spiritual perspective.



Culture, religion, and spirituality of patients and their families have an effect on the delivery of nursing care. While culture is a set of characteristics demonstrating the way a group of people lives, religion is an organized belief system accepted by a group of people who join together to worship God or a higher power and express and experience spirituality (Connerton & Moe, 2018). Culturally competent healthcare includes meeting the religious needs of patients and families (Swihart et al., 2021). Although there is no common definition of spirituality, we offer the following insight into its significance. Spirituality is a lifelong journey for the meaning and purpose of life through relationships with God, self, and others, coalescing the mind, body, and spirit (Connerton & Moe, 2018). Composed of one's beliefs and values, spirituality has been described as the breath that gives life expressed through practices, traditions, and rituals (Pearson Education, 2019).


Prayer practices are influenced by spirituality and may or may not be influenced by culture and religion. Under the umbrella of spirituality, nurses should consider all facets of beliefs related to a higher power, lifelong quest for purpose, personal relationships, acceptance, and faith. Spiritual needs and spiritual care are specific to the patient's or family's emotional needs; they are unique in nature and remain an essential component of holistic nursing care (Connerton & Moe, 2018). Praying with a patient when the patient needs prayer is a nursing intervention vital to spiritual care, bringing comfort and peace to patients and their families (Connerton & Moe, 2018).


Kim-Godwin (2013) believes professional growth in providing spiritual care is achieved when the nurse comprehends the importance of prayer rituals to patients; she also contends that nurses receive personal benefits and provide a higher level of professional and holistic practice by praying with patients.


Cross-culturally, prayer and religious beliefs and practices have positive effects on pain reduction, illness prevention, postsurgical recovery, and mental illness; these practices are helpful coping strategies during stressful events associated with physical illnesses (Eilami et al., 2019; Erci et al., 2014; Rezaei et al., 2008; Walton, 2007). For example, a study by Nasiri et al. (2020) concluded that reciting the name of God could reduce the anxiety and pain associated with dressing changes in burn patients. In a study of Muslim cancer patients, Rezaei et al. (2008) called prayer a valuable coping strategy, suggesting healthcare providers who encourage prayer are augmenting holistic care.



There are barriers to spiritual care provision and prayer. Nurses are cautioned regarding the practice of prayer with patients, as this places the nurse at risk for disciplinary action, such as being chastised, punished, or even suspended from work (Schoonover-Shoffner, 2013; Taylor, et al., 2019; Taylor et al., 2017). Nurses have been reminded by employers or supervisors to ensure that prayer is patient-initiated, not nurse-initiated (Nursing Times, 2009). Nurses may hesitate to provide spiritual care due to concerns such as crossing boundaries and evangelizing or fears of trespassing (Deal & Grassley, 2012; Taylor et al., 2017).


The patients' spiritual needs and the nurses' spiritual beliefs and practices lie somewhere in this continuum. Should the nurse ignore a patient's request for prayer? Spirituality is an integral part of oneself and nurses must recognize how their spirituality affects their professional caring (Taylor et al., 2017). Although participating in prayer with patients is considered spiritual care (Kim-Godwin, 2013), nurses remain fearful and insecure of employers' expectations and acceptance of prayer as an intervention (Taylor et al., 2019).


In nonfaith-based educational settings, instilling in students the importance of prayer as part of spiritual care remains crucial, but may be less integrated in the curriculum or modeled by faculty. Hawthorne and Gordon (2020) report curricular content deficits and unprepared educators who relied on individual beliefs when teaching spiritual care. Many secular nursing curriculums report using spiritual content provided by Assessment Technologies Inc. (ATI) to help students understand the importance of spiritual assessment and care and promote National Council Licensure Exam (NCLEX) exam success. Assessment Technologies Inc. reports working with 2,500 nursing programs worldwide (ATI, 2021). They include religion under the umbrella of culture, incorporating religious views as subcultures. Other subcultures embody values, ethnicity, and occupations. Assessment Technologies Inc. lists prayer as a nursing consideration, instructing students to provide privacy and support for the patient while praying. Meditation, prayer, and grief work appear under rituals, religious practices, death rituals, and faith healing (ATI, 2019).



Despite its consistently high ratings of importance (Taylor et al., 2017), prayer with patients continues to be infrequent. Educating prelicensure nurses about the positive outcomes of prayer can improve the potential for nurses to develop their skill and readiness to pray with or for patients as is appropriate and ethical.


What should educators teach nursing students about providing spiritual care? First, students must grasp the importance of meeting spiritual needs or finding someone who can (Deal & Grassley, 2012). Minton et al. (2016) suggested that "educators must nurture opportunities for students and novice nurses to learn and engage in the reflective preparation required to respond to patient prayer requests" (p. 2185). Anticipatory self-reflection about how to respond prepares students for future patient interactions that are related to prayer. Christensen et al. (2018) lists the benefits of such self-reflection: increased insight into one's personal feelings, greater capacity for empathy, and the ability to differentiate between the needs of the patient versus the healthcare provider.


Providing prayer as a nursing intervention helps patients achieve relaxation, rest, calm, well-being, and peace (Green, 2018). Many patients have identified prayer as their choice coping method, as it empowers them to navigate medical crises while decreasing stress and anxiety (Carneiro et al., 2020; Deal & Grassley, 2012; Kim-Godwin, 2013).


Taylor et al. (2019), Hawthorne and Gordon (2020), and Southard (2020) called for improved spiritual care education and support for nurses. When prelicensure nurses learn to pray with patients and families, certainty and confidence develop within the nurse, whereas faith and hope can increase for the patient. Ultimately, the trusting component of the nurse-patient relationship becomes strengthened.


Taylor et al. (2017) reported a lack of information about the frequency of nurses providing spiritual care despite the assumption of the intervention's validity and importance, suggesting spiritual care can be modeled and taught to nurses. Nurses have reported a lack of confidence in knowing how to respond when patients request prayer (Minton et al., 2016). Prayer focused nurse-patient conversations are sometimes unexpected and can be emotionally draining, requiring the nurse to reach deep within (Deal & Grassley, 2012).



In teaching how to pray with and for patients, educators must incorporate ethical parameters. A first step is to explain and assist students to practice self-awareness of their own spirituality and prayer practices that might influence their caring (O'Connell et al., 2019). For example, "an offer of prayer may reflect the nurse's personal needs and way of addressing suffering, but not the patient's" (p. 133).


Asking a patient if a prayer is acceptable or desirable in a noncoercive manner moves the impetus for prayer to the patient and away from the nurse. O'Connell et al. (2019) state that "it is pivotal that nurses be educated to observe ethical guidelines so that prayer can be introduced in patient care noncoercively and therapeutically" (p. 138).


Taylor (2020) recommends students and nurses who are evaluating the potential for prayer in the healthcare setting engage in a self-check: "If any motivation to offer a prayer is clouded by a need be a savior, to comfort or glorify oneself, or to control or convert the patient, it then becomes unethical and even harmful to the nurse-patient relationship" (para 5).


Educators can assist students to recognize and learn to maintain the neutral balance of power between a patient and clinician, remain attentive to the patients' vulnerabilities, and promote their autonomy (Green, 2018; McMillan & Taylor, 2018).



In an online survey of nurses related to provision of spiritual care, Taylor et al. (2019) concluded that the greater a nurse's personal religiosity and frequency of personal prayer, the higher the likelihood that the nurse will provide spiritual care. Thus, as educators work with students throughout the nursing program, educators can emulate and mentor students in their growth and commitment to their personal spirituality and prayer life; over time, this can result in a stronger inclination to pray with and for patients.


According to a leading faith-based school of nursing faculty member, prayer between faculty and nursing students is encouraged every day of their curriculum. Nursing faculty at Liberty University in Lynchburg, VA, role-model prayer with patients when requested, so nursing students learn to pray with their patients. Reportedly, patients and their families are thankful for the spiritual care they receive from these students. This nursing program encourages spiritual care integration throughout all of their university programs.


Hawthorne and Gordon (2020) suggest creating simulated experiences and letting students practice providing spiritual care to increase their proficiency and comfort levels. These activities can use reflection techniques and self-assessment tools (Hawthorne & Gordon, 2020) and help students acknowledge and explore their spirituality (Southard, 2020). Educators should teach students soft skills, authentic presence (Southard, 2020), and active listening, explaining that nurses can offer spiritual care irrespective of patients' or nurses' religious beliefs (Deal & Grassley, 2012).


In demonstrating how to pray with a patient, educators can model how to approach the patient. When assessing whether a patient would like prayer, Taylor (2020) suggests asking the patient in a respectful manner, "Would a prayer be helpful?" If the patient agrees to prayer, the next step is asking what the person would like to pray about and how prayer is preferred. Educators also can help students learn to watch for cues from the patient (Taylor, 2020).


Facilitation of open communication by the nurse and a willingness to discuss spirituality issues are often missed opportunities, according to Southard (2020); these opportunities offer the chance to improve communication and provide the patient with an invitation to discuss their spiritual needs (Isaac et al., 2016). Faculty can offer to students insights they have used to recognize opportunities to communicate. This invitation to communicate will ease the approach for a spiritual assessment, which is vital in ensuring the patient's beliefs and needs are acknowledged and respected when facilitating spiritual care (Kim-Godwin, 2013).


When faculty and preceptors role-model praying with patients, students and nurses are emboldened to implement spiritual caring. Green (2018) stated comfortability with prayer will vary for each nurse, whereas Taylor et al. (2017) described nurses' inner tension when spiritual care is infrequent. Green encouraged nurses who are uncomfortable praying with patients to request another nurse to facilitate the prayer. A more ethical approach is letting prayers be patient-led (Green, 2018). Kincheloe et al. (2018) recommended strategies to decrease the obstacles for implementing spiritual care. Among these suggestions were customizing a spiritual care toolkit supplied with culturally sensitive faith resources-books, devotionals, hymnals, crosses and rosaries, music, and movies-and implementing spiritual communication training using these resources.


The authors have participated in and led prayers with patients and families, as staff nurses and in the faculty role, to promote comfort and spiritual healing. Examples of Christian prayers used by the authors are the Lord's Prayer (Matthew 6:9-13), Psalm 23, and personally created prayers. One personally created prayer that has special meaning and may provide spiritual comfort includes the following words:


Father God, we lift up this child of yours who is facing illness and is struggling today. We ask that you bring healing to their body and comfort and peace to their soul. Calm their fears and let them experience the healing power of your love. In Jesus' name, we pray. Amen.


Kim-Godwin (2013) suggests that nurses consider praying a private, silent prayer when uncertain about praying with the patient. This option provides nursing students and novice nurses the ability to offer spiritual care when feeling uneasy with nurse-led prayer. If discomfort with praying remains, educators can share patients' insight: listen; say little; hold advice; and be present (Deal, 2011).



Teaching and modeling prayer for students should include the aspect of evaluation of the effectiveness of prayer as a nursing intervention. This facet has been challenging to measure objectively, so nurses must continue to assess their patients for resolution, control, or improvement in behaviors or symptoms that were present before intervening. Current research provides evidence of positive effects for patients with prayer, such as increased hope, contentment, calmness, and peace, translating into decreases in suicide, anxiety, and depression (Connerton & Moe, 2018). These outcomes encourage patients, reduce stress for family members and caregivers, and reduce treatment costs (Leet, 2018). Patient symptoms demonstrating improvement with prayer include pain, cardiac function, effects of cancer, increased tolerance of mental, emotional, and physical requirements of illness, along with increased satisfaction with treatments and healthcare (Harrad et al., 2019). Nursing diagnoses that promote planning care for patients requiring prayer as an intervention may include spiritual distress, fear, social isolation, dysfunctional grief, hopelessness, and ineffective coping (Connerton & Moe, 2018).



Regardless of difficulties encountered when measuring the outcomes of prayer, there remains a shared belief among the general population regarding prayer's healing power (Kim-Godwin, 2013). Teaching and modeling prayer as a spiritually competent intervention is a vital part of the prelicensure nurse's foundational education. Evidence exists that the trusting component of the nurse-patient relationship is strengthened when students and nurses pray with patients and families (See Sidebar). As faculty and preceptors role-model praying with patients, students can begin to exercise spiritual competency. Believing when James 5:15 (NIV) tells us that "prayer offered in faith will make the sick person well," nurse educators must prepare future nurses to pray with patients in order to achieve spiritual competency, providing comfort to all.


SIDEBAR: Personal Experiences with Prayer Interventions

In addition to the research, the authors have personal experiences with the efficacy of prayer as an intervention. The authors assembled these qualitative examples. In the first account, the prayer intervention was omitted.


When my father was hospitalized and subsequently received a terminal diagnosis, I was devastated. As a nurse, I completely understood the meaning of his diagnosis and prognosis. I remained strong and continually supported my father and family as we navigated through healthcare. Our minister and church family came to visit and prayed with us, but none of the medical caregivers prayed with our family or my father. I firmly believe this would have been a comfort to all of us, including myself. I needed that spiritual comfort from the people I related to the most.


Following my father's death, I realized I needed assistance with my grief. Being in the role of strong support in my family, I sought Christian counseling from a local hospice chaplain. This was an amazing experience that took me on a journey of acceptance and healing. Through my father's death, I learned that strong people need spiritual support and may not know where to receive this. Spiritual strength is essential while grieving and we often need others to lift us up when we are down.


In this account, the nurse initiated family-centered prayer.


As a nurse and family member, I have experienced the benefits of having nurses use prayer as an intervention. Before my beloved grandmother passed away in a nursing home, both the director of nurses and the hospice nurse asked if the family would like to pray. I am not sure I can express in words how much comfort, peace, and newfound trust in the healthcare team the intervention of prayer provided me as a family member.


Two examples of prayer interventions demonstrate praying with the patient and praying for the patient.


When the nurse anesthetist arrived with the perioperative transport team to take my mother for back surgery, I asked if they would join us in prayer. To my relief, they paused and bowed their heads. None of them added to our prayer, but getting to pray over my mother and her perioperative team gave us relief and peace.


Hours later, on the postsurgical floor, my sister and I were distressed to find our mother crying. At her bedside, we felt helpless and overwhelmed. Within minutes of her arrival to the room, our mother's nurse asked if she'd like a prayer. Crying, our mother said, "Yes." For the next couple of minutes, our nurse said the most beautiful prayers for our mother. As she prayed, the effect was medicinal. My sister and I felt relief as our worries diminished. We had prayed for our mother, but when someone else was praying for her, we felt like we did not have to do it all by ourselves. We were thankful to be in a hospital where prayer was supported and encouraged.


Web Resources


* Journal of Christian Nursing topical collections Exploring Spirituality


* FAQs in Spiritual Care


* Mayo Clinic Spirituality & Healthcare Resources


* Nurses Christian Fellowship Spiritual Care Resources




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Assessment Technologies Institute. (2019). Fundamentals for nursing review module (10th ed.).


Assessment Technologies Institute. (2021). Data and analytics.


Carneiro E. M., Tosta A. M., Antonelli I. B. S., Soares V. M., Oliveira L. F. A., Borges R. M. C., da Silva A. P., Borges M. F. (2020). Effect of spiritist "passe" on preoperative anxiety of surgical patients: A randomized controlled trial, double-blind. Journal of Religion and Health, 59(4), 1728-1739.[Context Link]


Christensen A. R., Cook T. E., Arnold R. M. (2018). How should clinicians respond to requests from patients to participate in prayer? AMA Journal of Ethics, 20(7), E621-E629.[Context Link]


Connerton C. S., Moe C. S. (2018). The essence of spiritual care. Creative Nursing, 24(1), 36-41.[Context Link]


Deal B. (2011). Finding meaning in suffering. Holistic Nursing Practice, 25(4), 205-210.[Context Link]


Deal B., Grassley J. S. (2012). The lived experience of giving spiritual care: A phenomenological study of nephrology nurses working in acute and chronic hemodialysis settings. Nephrology Nursing Journal, 39(6), 471-481.[Context Link]


Eilami O., Moslemirad M., Naimi E., Babuei A., Rezaei K. (2019). The effect of religious psychotherapy emphasizing the importance of prayers on mental health and pain in cancer patients. Journal of Religion and Health, 58(2), 444-451.[Context Link]


Erci B., Karabulut N., Ucuzal M. (2014). Psychometric evaluation of the adapted prayer scale in Muslim cancer patients. Journal of Hospice & Palliative Nursing, 16(8), 495-502.[Context Link]


Green C. A. (2018). Complimentary care: When our patients request to pray. Journal of Religion and Health, 57(3), 1179-1182.[Context Link]


Harrad R., Cosentino C., Keasley R., Sulla F. (2019). Spiritual care in nursing: An overview of the measures used to assess spiritual care provision and related factors amongst nurses. Acta Biomedica, 90(4-S), 44-55.[Context Link]


Hawthorne D. M., Gordon S. C. (2020). The invisibility of spiritual nursing care in clinical practice. Journal of Holistic Nursing, 38(1), 147-155.[Context Link]


Isaac K. S., Hay J. L., Lubetkin E. I. (2016). Incorporating spirituality in primary care. Journal of Religion and Health, 55(3), 1065-1077.[Context Link]


Kim-Godwin Y. (2013). Prayer in clinical practice: What does evidence support? Journal of Christian Nursing, 30(4), 208-215.[Context Link]


Kincheloe D. D., Stallings Welden L. M., White A. (2018). A spiritual care toolkit: An evidence-based solution to meet spiritual needs. Journal of Clinical Nursing, 27(7-8), 1612-1620.[Context Link]


Leet J. E. (2018). Benefits of prayer on depression in elderly adults. [Walden Dissertations and Doctoral Studies Collection]. Walden University.[Context Link]


McMillan K., Taylor E. J. (2018). Hospitalized patients' responses to offers of prayer. Journal of Religion and Health, 57(1), 279-290.[Context Link]


Minton M. E., Isaacson M., Banik D. (2016). Prayer and the registered nurse (PRN): Nurses' reports of ease and dis-ease with patient-initiated prayer request. Journal of Advanced Nursing, 72(9), 2185-2195.[Context Link]


Nasiri M., Bahdori H., Heydari A., Jafari A. A., Amiri M. H. (2020). The effect of reciting the name of God on the pain and anxiety experienced by burn patients during dressing change. Heath, Spirituality and Medical Ethics, 7(3), 3-8.[Context Link]


Nursing Times. (2009, February 24). A Christian nurse suspended for offering to pray has sparked health care and religion debate.[Context Link]


O'Connell-Persaud S., Dehom S., Mamier I., Gober-Park C., Taylor E. J. (2019). Online survey of nurses' personal and professional praying. Holistic Nursing Practice, 33(3), 131-140.


Pearson Education. (2019). Nursing: A concept-based approach to learning (3rd ed.). Pearson. [Context Link]


Rezaei M., Adib-Hajbaghery M., Seyedfatemi N., Hoseini F. (2008). Prayer in Iranian cancer patients undergoing chemotherapy. Complementary Therapies in Clinical Practice, 14(2), 90-97.[Context Link]


Schoonover-Shoffner K. (2013). Praying with patients. Journal of Christian Nursing, 30(4), 197.[Context Link]


Southard M. E. (2020). Spirituality: The missing link for holistic health care. Journal of Holistic Nursing, 38(1), 4-7.[Context Link]


Swihart D. L., Yarrarapu S. N. S., Martin R. L. (2021). Cultural religious competence in clinical practice. StatPearls. [Internet].[Context Link]


Taylor E. J. (2020). Initial spiritual screening and assessment: Five things to remember. Journal of Hospice and Palliative Care, 23(1), 1-4.[Context Link]


Taylor E. J., Gober-Park C., Schoonover-Shoffner K., Mamier I., Somaiya C. K., Bahjri K. (2019). Nurse religiosity and spiritual care: An online survey. Clinical Nursing Research, 28(5), 636-652.[Context Link]


Taylor E. J., Mamier I., Ricci-Allegra P., Foith J. (2017). Self-reported frequency of nurse-provided spiritual care. Applied Nursing Research, 35, 30-35.[Context Link]


Walton J. (2007). Prayer warriors: A grounded theory study of American Indians receiving hemodialysis. Nephrology Nursing Journal, 34(4), 377-386.[Context Link]


Wittenberg E., Ragan S. L., Ferrell B. (2017). Exploring nurse communication about spirituality. The American Journal of Hospice and Palliative Care, 34(6), 566-571.[Context Link]