Spiritual Care by Nurses

Posted on May 5, 2012 by

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I have long been interested in how, why, when of nursing providing spiritual care for patients. In my work as a hospice nurse, I found that creating a spiritual-caring-healing environment for patients and their families was the most rewarding experience within this role.

I am currently attending a spiritual care training course at a local hospital, and I was pleased to learn that there is a lot of research forthcoming around the idea of spiritual pain contributing to overall comfort levels. Spiritual pain likely also increases anxiety, which we know contributes greatly to the pain cycle process. Meanwhile, nurses are so involved in the other demands placed on them, they are either unable to provide spiritual care of under-educated in how to provide spiritual care. This will be an issue with ongoing CMS regulations about outcomes and pain levels (I am thinking particularly with the new hospice demand that patient’s last reported pain level be a level 4). Additionally morphine and ativan do not address spiritual pain; the healing presence of another, connection, and prayer do address spiritual pain and this is where nursing seems to be lagging both in academia and practice.

The chaplain running the spiritual care program tells us that more and more, the spiritual care referrals are coming from the hospitalists, and less and less from nurses; the doctors are interested in supporting the spirituality of the healing process, in part because spiritual care and decreased spiritual pain lead to shorter lengths of stay and better outcomes. They seem to be making the connection between spiritual needs and being addressed and the patients’ positive outcomes. Meanwhile, the nurses seem to be growing further and further away from our historical roots of providing spiritual care to patients.

It seems one of the challenges is defining spiritual care; in our Western culture where there is such a diverse array of religious and spiritual practices, we may struggle to figure out how to address people’s individual beliefs. I would argue though that by applying a nursing theory such as Watson’s Human Caring Theory, we can begin to create caring-healing experiences that support the evolution and spiritual needs of all of our patients, regardless of their religious or spiritual beliefs.

If we take the time to “be with” our patients, set an intention of caring and healing, our presence becomes the greatest tool to supporting the spiritual needs of patients. We also reap the rewards of this supportive process by creating this inter-connected experience, from which we learn and grow. Tools that support our being with patients include use of healing and holistic modalities such as Reiki, massage, yoga, and aromatherapy.

The challenge remains how to incorporate these holistic modalities in both the nursing academic setting and the practice setting. While I have worked to develop courses that address this, I believe that the self-reflective practices are a good place to start as we support students and nursing in their endeavors to create practices that support the healing process of others. For most of us, this is why we became nurses to begin with.

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