1. Rotter, Briana

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My work as a nurse practitioner takes me into close, ongoing contact with patients as I give primary care services to those confined to home due to advanced chronic disease and life-limiting illnesses. This role enables me to weave palliative care into the primary care I offer each patient. I also have been able to practice spiritual care with these individuals, who are confronting their mortality and often wrestling with spiritual questions and concerns. With each patient, I discuss goals of care, perform symptom management, make a spiritual assessment, and collaborate with other nurses, chaplains, and social workers.

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My journey with palliative care began five years ago when a dear friend passed away of cancer. Jessica,* who died before her 35th birthday, battled metastatic breast cancer at the same time that I was studying in a nurse practitioner program with a palliative care focus.


In Jessica's situation, prayer was our weapon against fear, physical discomfort, and the unknown. Daily, I prayed for Jessica's healing, as did she. Our prayers weren't answered the way we hoped, but even so, whether at the grocery store, physician's office, or church, Jessica, with a relentless faith, shared her hope in God who has conquered the power of death. In Jessica's case, my role in spiritual care was as a partner, helping her move through the end of her life, still holding onto God.


However, Martha*, another patient that I cared for, experienced a different spiritual course. She had lived a long life and had trouble reconciling her Christian faith with the suffering she experienced. At my first visit, Martha had significant dyspnea. After ruling out obvious causes, we began working on her anxiety and pain control. After performing a spiritual assessment, at each visit I offered to pray with her. Martha always said yes. Each time I prayed, her anxiety reduced dramatically. When I told Martha about my journey to become a primary palliative nurse practitioner, Martha burst into tears and hugged me. This opened the way for us to discuss how our personal suffering can deepen our faith in God. By sharing some of my experiences of suffering and God's mercy and kindness, Martha gained more confidence and steadiness in her faith.


As nurses, we are responsible to accurately assess the spiritual condition of our patients. Questions such as, "Is there anything worrying you?" or "Are there sources of hope or support in your life that I can help you with?" may open communication or opportunity to listen to a person's spiritual needs. As the nurse learns of the patient's spiritual coping methods, she or he can support and encourage the use of those methods during continued interactions.


Whether a patient has faith in the God of the Bible, or another faith, opening communication about spirituality allows them to work through their questions and spiritual struggles, with the possibility of finding hope. "Honest communication provides opportunity for patients to find meaning and self-worth" (Lee, Forehand, St. Onge, & Acker, 2018, p. 262).


Over the 18 months that I cared for Martha, her diastolic congestive heart failure worsened. After she contracted pneumonia and was admitted to hospice, I continued to visit her. Three days before her death, she was unable to speak; I continued to offer the spiritual care that Martha had shown mattered to her, including prayer and sharing of the hope of life in Christ.


I also shared one of Jessica's favorite verses, Revelation 21:4 (NIV): "He will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away." A tear rolled down Martha's cheek as she squeezed my hand and nodded. I wiped her tears. A few weeks after she passed away, Martha's daughter wrote to me, describing how Martha's faith had grown because I was an answer to her prayers.


As Christian nurses, our words, actions, and questions can help patients who are nearing the end of their lives to utilize their spiritual beliefs.


Lee S. B., Forehand J. W., St. Onge J. L., Acker K. A. (2018). Helping bridge the great divides: Supporting nurse communication at end of life. Journal of Christian Nursing, 35(4), 258-262. doi:10.1097/CNJ.0000000000000542 [Context Link]