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IN NURSING we carefully monitor vital signs-pulse, respirations, blood pressure, temperature-because these four signs are vital to life. Pain has been referred to as the fifth vital sign due to its significance. Perhaps spirituality should be considered the sixth vital sign. Spiritual status is crucial to life, if not at the heart of our being. Of course, spiritual status can be ignored since the consequences of spiritual neglect may not show up until a crisis occurs. But in crisis, spirituality suddenly becomes a top priority.


As nurses we work where crisis is common. We observe this sixth vital sign and its impact on the other vital signs. Health science literature documents this association. For example, there is a positive correlation between depth of religious belief and physical and mental health. Spirituality plays a role in preventing mental and physical illness, improving how people cope with illness, and facilitating recovery from illness. Studies of the chronically ill reveal that spiritual focus and spiritual well-being increase with advancing age and the progression of chronic illness. Researchers also confirm that people think about their spiritual life more when they are sick.1


Scripture confirms spiritual vitality as a primary vital sign of life. For example, connection with God helps us sleep better (Ps 4:8,16:8-9), while spiritual distress brings anguish (Ps 25:16-18), weighs us down (Prov 12:25) and dries up the bones (Prov 17:22). King David said there was no health in his body, his heart pounded and strength failed; even the light was gone from his eyes because of sin and broken relationship with God (Ps 38). Conversely, a heart at peace gives life to the body (Prov 14:30). These are but a few of many references in the Bible pointing to the strong association between spiritual health and physical, mental and emotional health.


Unfortunately, health care professionals don't routinely monitor this sixth vital sign. In a survey reported in the American Family Physician, patients said that physicians rarely discuss spiritual matters.2 Nurses also overlook spiritual needs. In an analysis of spiritual care research, nurse researcher Elizabeth Johnston Taylor found that although nurses believe clients have spiritual needs, they report "not much is done" to meet those needs, and they feel poorly equipped to do so.3 In a previous FAQs column, I offered reasons why nurses don't address spiritual needs: confusion regarding religious beliefs versus spirituality; fear of getting into something they can't handle; lack of self-knowledge regarding spirituality; inadequate training; or fear of intruding on a patient's privacy4


Not surprisingly, Taylor discovered the most significant and central aspect of spiritual care reported by patients is caring. Patients say caring by the nurse-establishing a caring relationship characterized by being present, listening, respecting and giving of self--is more important than what may be considered "typical" spiritual interventions, such as referring to clergy, prayer or offering religious literature. Noted nurse theorist Patricia Benner says caring sets up what matters to a person; it sets up the possibility of giving and receiving help. She summarizes that caring is primary.5 Caring allows the nurse to understand the patient's experience. Interestingly, elements of caring are some of the same elements vital to spiritual health: compassion, sharing, supporting, showing empathy, competence, honesty and trustworthiness.


When patients are coping with chronic or life-threatening illness, they are at their lowest. Nurses, who are physically present, have the best opportunity to address the sixth vital sign.


1 Caroline Young and Cyndie Koopsen, "Spirituality, Religion, and Health" in Spirituality, Health, and Healing (Thoro-fare, NJ: Slack, 2005): 59-72; Debra O'Neill and Elaine Kenny, "Spirituality and Chronic Illness," Image: Journal of Nursing Scholarship 30, no. 3 (l998): 275-79. [Context Link]


2 Walter Larimore, "Providing Basic Spiritual Care for Patients: Should It Be the Exclusive Domain of Pastoral Professionals?" American Family Physician 63, no.1 (2001): 36-40. [Context Link]


3 Elizabeth Johnston Taylor, "What Have We Learned from Spiritual Care Research?" JCN 22, no. 1 (Winter 2005): 22-28. [Context Link]


4 Mary T. Sweat, "Does Knowing a Patients Religion Help or Hinder?" JCN 23, no. 2 (Spring 2006): 41. [Context Link]


5 Patricia Benner and Judith Wrubel, The Primacy of Caring (Menlo Park, CA: Addison-Wesley, 1989): 1-5. [Context Link]