1. Posey, Deborah

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It was toward the beginning of the night shift in the intensive care unit (ICU). I was assessing a patient when it happened. I remember that smile, those teary brown eyes, and her earlier words, "It's alright. I'm going to see my Lord." The urge was strong to "thump" this patient's chest, to call a Code Blue, to yell for help while screaming in my mind, God, not now. Her family is on their way!

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It took everything I had in me not to do what I had been trained to do in a code situation. Working in the ICU since graduating from nursing school had conditioned me to react a certain way. Yet, for the first time in my nursing career, I was caring for an individual who decided not be resuscitated, declaring herself as "do not resuscitate" (DNR). Her reasoning, as she revealed to me after first greeting her, was that she had had a great life, family, and husband (who was now with God), but her weak heart had prevented her from enjoying her grandchildren. I remember asking her if she was ready for death, but before she could answer, her heart stopped.


What she wanted was, in most cases, not the norm. In fact, at that time in healthcare, well before COVID-19 and before the DNR order, advance directives could be ignored, and patients would have been kept alive. This occurred, in part, because the family or physicians could not deal with patient deaths on their consciences (Beckstrand et al., 2018; Carr & Luth, 2019).


I followed my patient's directive that night, but I regret not taking the initiative to talk more with this woman about her sense of spiritual needs, to assess if she had concerns about what would happen when she died. I had an inner prompting that I now believe was from the Holy Spirit when I entered her room, but I focused on physical assessment first. I pushed that "nudge" aside and concentrated on listening to her congested breath sounds and the loudest holosystolic murmur I had ever heard. Even though I felt compelled to ask her what she meant when she said, "It's alright. I'm going to see my Lord," I did not. At the time, I felt like I could not. I had been taught that there is a place, time, and person-the chaplain-who would address those issues. I thought of Job, the Old Testament example of faith, who retorted to his companions during his extended suffering, "For I am full of words, and the Spirit within me compels me" (Job 32:18). As a Christian wanting to be sensitive to spiritual needs, I look back and wonder what I could have done differently.


In nursing, no matter what unit you may be working on or the code status of your patients, if you feel prompted to explore spiritual needs, there is a reason for that prompt. As Christian nurses, we should be open to allowing God to work through us.


The psalmist sang, "He [God] heals the brokenhearted and binds up their wounds" (Psalm 147:3; NIV). What you may be prompted to say or do may be that very act or word that will help start a healing process for a person's broken heart or that of a family member.


As you move forward in your practice, keep growing in your knowledge of spiritual care and remember that following the leading of the Spirit is important. The effect of one act or word on another's life should never be underestimated when God is in the mix.


Web Resources


* Nurses Christian Fellowship


* Spiritual Care Association



Beckstrand R. L., Mallory C., Macintosh J. L. B., Luthy K. E. (2018). Critical care nurses' qualitative reports of experiences with family behaviors as obstacles in end-of-life care. Dimensions of Critical Care Nursing, 37(5), 251-258.[Context Link]


Carr D., Luth E. A. (2019). Well-being at the end of life. Annual Review of Sociology, 45(1), 515-534.[Context Link]