1. Smith, Amy Rex

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I work one day a week at the Brigham and Womens' Hospital in Boston on a busy medical intermediate care unit. As a staff nurse on the 3-11 shift, I often admit patients. My interest in spiritual care leads me to pay special attention to the spiritual needs screening section, a mere two questions on our voluminous nursing admission form: "Are there any religious or spiritual practices that would be helpful to you while you are here?" and "Would you like to see a chaplain?"

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Most patients welcome the questions, are eager to share about their faith, and appreciate the option of seeing a chaplain. For these patients, beginning a relationship that includes assessing and responding to spiritual needs is straightforward. But what about those few patients who react negatively to these questions, making it clear they want no spiritual intervention-including prayer. In respect for their wishes, I am careful to follow their requests and not offer spiritual conversation or prayer. Yet I wonder how they will cope with their hospitalization. Do they have spiritual support?


Clinical guidelines make it clear that prayer only is offered when invited by the patient. For example, the American College of Critical Care Medicine issued "Patient-Centered ICU Clinical Practice Guidelines" in 2007. Within the category of spiritual/religious support, it states, "If a patient requests that a healthcare provider pray with them, and the healthcare worker agrees and feels comfortable, the request is honored and is considered to be part of the spectrum of holistic intensive care" (Davidson et al., 2007, p. 612.) But there is more to prayer than verbal prayers with nurse and patient together.


Prayer permeates our lives as Christians. My day starts with a dedicated time for silence, reading Scripture, listening to God, and prayer. Prayer is constant throughout each day, an openness to God, a running conversation; a quick "Help me, Jesus," a spontaneous expression of thanks, or a moment of intercession. I could no more stop my prayer than I could stop my heart from beating. I imagine this experience is the same for many Christian nurses. Prayer dominates our personal, spiritual realm. We follow Jesus' example (i.e., Matthew 6:9; 14:23) and numerous biblical teachings to pray (Ephesians 6:18; Colossians 4:2; 1 Thessalonians 5:17; Jude 1:20).


Kiehne (2004) used a phenomenological approach in her doctoral dissertation to describe the lived experience of nurses who pray for their patients. The nurses she studied prayed for patients in direct and indirect ways. A few selected examples are:


* The ability to function as God's agent in providing care


* For guidance in clinical decision making


* For procedures to go well


* For God's will in their patients' lives (p. 82).



She identified how when nurses pray for their patients-that is, not with the patient but privately, prayer was no longer contained in the personal, spiritual realm of the nurse but moved to being framed within the nurse-patient relationship (pp. 91-92). She also carefully addressed the ethical issues involved in prayer for patients, most centrally the need to balance the patient's right to autonomy with the nurses' right to do good (beneficence). Her final description states that "[prayer] serves as a way of maintaining their [nurses] personal integrity by aligning their spiritual lives with their professional lives. As a result of this alignment, praying for patients often becomes a necessary constituent of their nursing care" (p. 81).


There is no easy answer to the question of whether we can pray for our patients who explicitly do not want prayer. Of course, we never pray out loud with patients unless they request and/or consent to prayer. With quiet, internal prayer, we must take care to maintain the delicate ethical balance of being true to our authentic spiritual selves while still respecting the patient's right to choose. For each individual patient, we need to pause and listen to discover how-and how not-to pray.


Davidson, J. E., Powers, K., Hedayat, K. M., Tieszen, M., Kon, A. A., Shepard, E., & Armstrong, D. (2007). Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine task force 2004-2005. Critical Care Medicine, 35(2), 605-622.


Kiehne, A. (2004). The lived experience of nurses who pray for their patients: A phenomenological journey. Unpublished doctoral dissertation, Temple University, Philadelphia, PA. [Context Link]