Recently spiritual care has been in the nursing news-and not in a positive light. The April 17, 2009 American Nurses Association (ANA) SmartBrief Top Story, "Nurses walk fine line talking religion with patients" reported on a nurse losing her per diem contract "after the patient's family complained that (the nurse) had distressed the patient by talking about repentance" (McCormick, 2009). The story perked my interest; a nurse in trouble for spiritual care.
One wonders about such incidents and what they imply. The ANA summarized that "nurses can avoid problems by asking a trained chaplain to intervene with a patient" (ANA, 2009). While this may be true, our goal in spiritual care shouldn't be to "avoid problems," but to care for our patients. Sometimes this means consulting a chaplain, but we still offer spiritual care. In my work as a staff nurse, much of the time a chaplain isn't immediately available on hand when a patient is in spiritual distress. Even if a chaplain is available, I have rapport with the patient, I am with them in that moment, and I can offer spiritual care as we wait for the chaplain. Spiritual diagnoses, interventions, and outcomes have been designated by the North American Nursing Diagnosis Association (NANDA-I), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC), and the Joint Commission on Accreditation of Healthcare Organizations requires spiritual assessment and care. As nurses, we simply must offer spiritual care.
So what is appropriate spiritual care? Is it okay to talk about beliefs? Should we avoid religious words? What do patients need most in spiritual care?
As always, Jesus offers answers to these questions. His encounters with sick people demonstrate the best in spiritual care. Over and over the Bible tells us Jesus had compassion (Matthew 9:36, 14:14, 15:32, 20:34). When a man with leprosy came to him, Jesus was filled with compassion, touched the man, and healed him (Mark 1:40-42). After Lazarus died, Jesus was deeply moved (John 11:33, 38). What our patients need most from us is that we be deeply moved-about them, their situation, their pain, their needs. More than anything else-more than words, actions, or sharing religious ideas-spiritual care is about being deeply moved for those in our care.
What does this look like? In my experience it means watching and listening carefully and deeply to my patients, trying to discover their needs and search for effective ways to offer support. As a Christian it means watching and listening carefully and deeply to the Holy Spirit who dwells within me (John 14:16-17), believing God knows this person, how best to meet their needs, and that he will guide me in what he wants to do (John 14:26). This relationship with the Holy Spirit is born out of pursuing God in personal Bible study, prayer, meditation, and worship. Being deeply moved means I am ever aware that this patient and family in my care is vulnerable, that as their nurse I am in a unique position of power and must not take advantage of this in any way. It means as I interact with my patients, I cautiously and vigilantly ask myself, am I am looking to meet my needs (to feel better, to share my beliefs) or my patient's needs?
Sometimes being deeply moved means I am simply present, quiet, listening, caring. Sometimes I feel led to carefully ask good questions, listen, and ask more questions to help the patient through self-discovery ("Tell me more about what you're feeling [saying, thinking] [horizontal ellipsis]" "Where do you go for support, help, meaning, purpose?"). (For more good questions see Taylor, 2007; The Joint Commission, 2009). Sometimes patients indicate they want to know more about a specific belief system, and this may lead to discussing religious ideas. If a patient asks what I believe, it can be appropriate to answer questions. Sometimes it means helping a patient with a religious practice such as prayer.
In the end, the most crucial aspect of spiritual care isn't what I said, how long I spent with the patient, what I did. It is whether or not my patient experienced deep compassion and the same sense of caring that moved Jesus.
KSS