1. Sweat, Mary T.

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In these days when there is much caution about separation of church and state, and when HIPAA has mandated privacy for the individual, nurses may feel cautious in addressing spirituality with patients for fear of stepping on their rights or privacy. However, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has said that every patient has a right to care that considers the personal dignity and respect of spiritual values.


The nursing profession is at the forefront to address these spiritual issues, but studies show that nurses are not consistently addressing patients' spiritual needs.1 Barriers to nurses giving spiritual care include: 1) confusion regarding religious beliefs versus spirituality, 2) fear of getting into something they can't handle, 3) lack of self-knowledge regarding spirituality and 4) fear of intruding on patients' privacy.2 Lack of education in spiritual care also hinders nurses' ability to deal with clients' spiritual needs.


For the last seven semesters, I have asked students to submit questions they have about spiritual care and have found many questions resurfacing.


One of the first and most basic questions is:"Is it appropriate for nurses to provide spiritual care?" The answer to that question is an overwhelming yes!! Most clients want nurses to provide spiritual care, and nurses are in a position to provide that care.


However, sometimes clients refuse spiritual care, like Mrs. Brown (see Practicing, p. 41). It was clear Mrs. Brown wasn't a religious person, but she and her family had many spiritual needs. And because they declined a visit from the hospital chaplain, the nurse was in a crucial position to address those needs.


What were some of Mrs. Brown's needs? She was fearful and agitated in the evening when no family was present. This may have reflected the spiritual need for love and relatedness. Mrs. Brown relayed a meaningful life that included hard work on the farm and relating with her family. She also expressed feelings about things for the farm coming first, and new furniture taking a back seat. She mentioned putting the needs of food for the children above spending time with them. This might have reflected a need for forgiveness for herself and for family members. And Mrs. Brown may have been asking to have her spiritual needs met when she told the nurse she wanted her full attention, instead of doing the nurse things.


How did Katie meet Mrs. Brown's spiritual needs? Katie demonstrated the ministry of presence by giving Mrs. Brown her full attention. She facilitated Reminiscence Therapy as Mrs. Brown told her life story. There obviously was good rapport between patient and nurse because Mrs. Brown wanted this nurse to hear her story. Whether Katie realized it or not, she must have reflected the love of God to Mrs. Brown. Katie reflected back to Mrs. Brown strengths she saw in her life and an appreciation of the gift of hearing her life story. And Katie facilitated love and relatedness by allowing the family to be present with Mrs. Brown and making an effort to ensure that they would be at her bedside when she died.


When Katie asked about whether Mrs. Brown and her family wanted a pastor to visit, her response of "We're not religious" felt like a cut-off but may not have been. It may have meant only that the Browns were not connected with a church or had had a bad experience with clergy in the past. Katie could have asked other questions aimed at assessing intrinsic faith, such as, "What gives you comfort and hope?" "How do you see God involved in all of this?" "Do you find prayer helpful?" These questions might have opened the door for conversation about spiritual things and perhaps even led to Mrs. Brown exploring her relationship with God.


1 Karen Boutell and Fredrick Bozett, "Nurses' Assessment of Patients' Spirituality: Continuing Education Implications," The Journal of Continuing Education in Nursing 21, no. 4 (1990): 172-76. [Context Link]


2 Gayle Newshan, "Transcending the Physical: Spiritual Aspects of Pain in Patients with HIV and/or Cancer," Journal of Advanced Nursing 28, no. 6 (1998): 1236-241. [Context Link]