Spirituality in nursing practice and patient care

Nursing - Spirituality

SPIRITUALITY, PRAYER, and the ROLE of NURSES Abstract:

The vast majority of all hospitalized patients maintain some formal religious belief or a general belief in a higher power. Many of them believe in the power of prayer, particularly when faced with serious personal problems including medical illnesses. The role of the nurse includes facilitating any positive behaviors or perceptions that benefits the emotional, medical, and physical health of the patient. Joint prayer may often be beneficial to patients, but the involvement of nurses in prayer raises several issues. First, praying with patients may be perceived as personal intrusion in private affairs; second, denominational differences may conflict with joint prayer; and third, different individuals maintain different praying styles and beliefs about prayer, even among similar religious faiths.

The role of the nurse is, therefore, to ascertain a patient's receptivity to joint prayer and to conform to the patient's wishes about prayer and about whether or not joint prayer with nurses is even welcome. In situations where the patient is receptive to joint prayer but maintains a different religious perspective, the role of the nurse is to extract common principles from their respective beliefs and values to enable them to participate in prayer without offending the patient or detracting from the beneficial value of joint prayer. Successful implementation of this approach requires providing appropriate instruction to nursing staff to maximize the value of joint prayer efforts.

Introduction and Statement of the Problem:

The vast majority of all human cultures maintain a belief in a higher power or God. Many individuals who believe in God also engage in regular prayer, but it is a function of human nature that those who already pray do so more regularly and more often when faced with acute personal crises such as medical illness. Likewise, many of those who believe generally in a Supreme Being or a God either do not ordinarily pray at all or do so only occasionally but tend to pray much more frequently in times of personal and family crises (Cavendish, Konecny, Krayuyak-Luise, et al., 2004).

To the extent patients happen to share both a personal rapport with their nurses and to the extent patients share similar spiritual perspectives or specific religious beliefs and orientation with their nurses, they often greatly appreciate the willingness of their nurses to join them in prayer (Grant, 2004). On the other hand, in the absence of such personal rapport and where nurse and patient maintain incompatible spiritual perspectives or specific religious beliefs, the nurse's efforts to participate in the patient's spiritual communications may be more detrimental than beneficial to the patient (Johnston-Taylor, 2003).

Therefore, to ensure that the efforts of nurses to participate in the spiritual component of their patient's recovery and well-being, nurses must adhere to fundamental guidelines to maximize the potential value of joint prayer. Once those guidelines are established in principle, the effectiveness of joint prayer between nurses and patients still requires specific implementation through continuing nursing education and training.

Proposal for Solution:

Naturally, patients are most likely to welcome any involvement of their nurses on a more personal and private areas such as spiritual beliefs in general and joint prayer in particular to the extent they share a personal rapport, irrespective of different spiritual perspective or religious belief (Galek, Flannelly, Vane, et al., 2005). Therefore, the first fundamental principle to any effort of nurses to become involved in more personal matters in their patients' lives is the importance of establishing personal rapport through traditional mechanisms such as expressions of concern and sensitivity toward their needs and emotions during the normal course of patient care.

Particularly where patient and nurse already share the same spiritual perspective and/or religious beliefs and values, establishing personal rapport is often the only determinant of patient receptivity to the involvement of the nurse in spiritual matters such as prayer. Many nurses are aware that empirical studies have documented the beneficial role of spirituality and prayer during serious illness such as cancer (Johnston-Taylor, 2003; Villagomeza, 2005), but remain hesitant to intrude into their patients' personal affairs.

Conversely, other nurses may actually believe that their own religious traditions require them to share their religious beliefs with patients, particularly in connection with end-of-life care (Campbell & Reed-Ash, 2007). Arguably, the imposition of one's own religious beliefs on patients - especially patients in compromised physical health and psychological strength - raises significant ethical issues because doing so may border on denying patients personal respect for their values and beliefs at a time when they are particularly vulnerable (Winslow & Winslow, 2003).

In principle, nurses who are reluctant to offer spiritual support must understand that politely offering to join patients in prayer is perfectly appropriate; on the other hand, nurses inclined to impose their own religious beliefs and values on patients is never appropriate. By instilling this understanding in nurses, it is possible to encourage nurses who are capable of better serving their patients but are reluctant to do so, while simultaneously minimizing the possibility that other nurses will unethically intrude into patients' private affairs in ways that are inconsistent with respect for patient autonomy (Johnston-Taylor, 2003; Winslow & Winslow, 2003).

The solution becomes much more complicated (even with the benefit of personal rapport) where nurse and patient do not share a general spiritual perspective or a specific religious tradition or belief system. In either situation, requesting permission from the patient beforehand is crucial; but where patient and nurse do not share similar spiritual beliefs, engaging in prayer without first requesting permission is more likely be perceived as an unwelcome personal intrusion and to offend patients, thereby eliminating any receptivity on their part to permitting joint prayer (Winslow & Winslow, 2003).

However, it is still possible to provide spiritual support (including joint prayer) even where nurse and patient maintain completely different religious beliefs, provided nurses first undertake to ascertain patients' spiritual beliefs and ask permission first, in conjunction with establishing personal rapport through their manner of providing traditional medical services (Winslow & Winslow, 2003). Specifically, nurses must also understand that spiritual support in the form of joint prayer is only ethical to the extent it is welcomed by the patient.

Similarly, even where welcomed, nurses must absolutely respect that their patients' personal religious beliefs, rather than those of nurses, must dictate the ultimate form of prayer that may be ethically encouraged by the nurse. In that regard, any form of proselytizing, even if the nurse believes that it is in the patient's best interests, is never appropriate because it violates the fundamental tenet of patient autonomy (Winslow & Winslow). Therefore, the ethical approach to providing spiritual support in general and to providing spiritual support in the form of joint prayer in particular absolutely requires that nurses learn to identify the common spiritual beliefs and values shared between their own religious perspectives and those of their patients and that they strictly limit their joint prayer efforts to those that comport with their patients' religious beliefs and avoid any specific types of spiritual support that conflict with patients' religious beliefs.

Implementation of the Solution:

As with other forms of specific nursing practices, implementing effective solutions relies primarily on education and training (Nuss-Kotecki, 2002). In view of the natural reluctance of many nurses to intrude on patients' private affairs, appropriate training in this area requires promoting the potential palliative value of appropriate forms of spiritual support. Similarly, such training must also emphasize the absolute supremacy of respecting both patients' desire (or lack of desire) for spiritual support in addition to respect for patients' personal religious beliefs.

Generally, the optimal mode of instruction includes lecture and video exposure to the full range of different religious viewpoints along with input and suggestions from religious leaders from different faiths. It is anticipated that both could be implemented with minimal cost within the general framework of continuing nursing education in patient care. The fundamental purpose of such training is to help nurses anticipate likely responses of different patients to any overtures in the realm of spiritual support, which may range from enthusiastic appreciation to near disgust. Once nurses understand the extent to which appropriate overtures are necessarily dictated by patient attitudes and religious belief systems, that training should emphasize the importance of first establishing personal rapport through their provision of traditional nursing services, first.

Perhaps the most important aspect of training in this area relates to negotiating fundamental differences in religious perspectives and belief systems. In principle, the appropriate method of providing spiritual support to patients whose religious beliefs differ from the practitioner's requires the nurse to first ascertain the patient's personal beliefs and then focus exclusively on areas of common ground or on general spiritual concepts instead of concepts that are particular to the nurse's own religious belief system.