ON A QUIET AFTERNOON Ba, a senior nursing student, cared for a dying man in the Veterans Administration Hospital. Mr. Marks, a 74-year-old Caucasian, was suffering from a rare form of cancer. He was on oxygen and could barely breathe, let alone speak. After introducing himself and asking Mr. Marks how he was feeling right now, to Ba's surprise, the man looked at him and gasped, "Now that I'm dying, I realize that I never really learned how to live."
Ba, 21, was overwhelmed. He had noticed on the admission report that Mr. Marks was Jewish, so he wondered about his personal faith or thoughts about life after death. Ba was raised in the Catholic faith tradition, and knowing the patient was Jewish intimidated him. Ba, who is Vietnamese, also figured Mr. Marks knew his faith was likely different from Ba's faith, a common fear that keeps nurses from addressing patients' spiritual needs.1 Ba wondered how being an army veteran played into Mr. Marks's current distress.
What could Ba say to this man in obvious spiritual distress? Does knowing Mr. Marks's faith tradition help or hinder in offering spiritual care?
Mr. Marks was communicating clear distress, searching for meaning and purpose. A good place to begin spiritual care, no matter what a patient's faith tradition, is to acknowledge his or her distress. Ba could say, "Mr. Marks, I can only imagine how difficult this must be for you. I'm so sorry you are going through this," then gently restate what the patient said, such as, "It is hard to look back on life and wonder what might have been, isn't it?" Depending on whether or not Mr. Marks clams up or talks more, Ba could ask open-ended questions to help the patient explore his thoughts. It would be important not to force Mr. Marks to talk if he did not want to, but in this case the patient initiated the discussion.2
Later the nurse could explore the extent Mr. Marks was practicing his faith and what his faith meant to him. Knowing the patient's faith could help Ba be aware of practices that might be meaningful to Mr. Marks. If Mr. Marks tells Ba he is an Orthodox Jew, this provides perspective into his possible opinions about the after-life or what constitutes a good life.
Having spiritual care reference books readily available on the unit can help staff check the basic beliefs of various faith traditions. Regular spiritual care conferences or discussions at staff meetings also help nurses be informed. Knowing common traditions and faith practices can break down barriers and build trust and a connection with the patient. Nurses might feel freer to express ideas without inadvertently offending or disrespecting thepatient or their beliefs.
Knowing a patient's religion can be a hindrance if the nurse has preconceived ideas about the particular faith tradition. Ideas can be incorrect or not accurate for an individual patient. If the nurse has biases about the faith, then interactions may be affected. Knowing the person's religion can give an attitude of generalization and prevent the nurse from addressing individual spiritual needs.
Knowing Mr. Marks is Jewish may not be as important as knowing he is terminally-ill and verbalizing hopelessness. The first and most appropriate intervention would be to explore his felt needs. Later, Ba could offer to contact the chaplain, social worker or other staff to learn more about Mr. Marks's family and faith community, or to arrange visits from his rabbi.
By implementing active listening, loving concern, and encouraging patients to verbalize pain and distress, we can bring comfort. Being with a patient-being fully present in body, mind and spirit as Jesus was-is one of the best ways to meet spiritual needs.3
1Julia Emblen and Perrie Peverall, "Spiritual Care: Lingering Questions" Journal of Christian Nursing 19, no.2 (Summer 2002): 17-20. [Context Link]
2Elizabeth Johnston Taylor, from "What Should I Say? Spiritual Care Strategies for Nurses," Nurses Christian Fellowship seminar, November 11, 2005, and in her forthcoming book, What Should I Say? Talking to Patients About Spirituality. [Context Link]
3Gayle Newshan, "Transcending the Physical: Spiritual Aspects of Pain in Patients with HIV and/or Cancer," Journal of Advanced Nursing 28, no. 6 (1988); Elizabeth JohnstonTaylor, "What Have We Learned frm Spiritual Care Research?" Journal of Christian Nursing 22, no. 1 (Winter 2005): 22-28. [Context Link]