Nay's Note by Naomi James, MSN RN CPAN CNEcl
September 2021
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Listen, You can help your client's psychosocial domain and spirituality without interfering with, offending, or disrespecting their religious beliefs or yours---and I want to dig deep into that conversation.
Nurses have been a part of spirituality and spiritual health for centuries. Many of the first Nurses that we learn about in our Nurse theory courses were nuns, priestess', or members of religious community groups. Most of their early Nurse work was centered on helping the patient navigate their spiritual well-being during their time of physical vulnerability. This was common and even expected. However, overtime, nursing professionals have lessened their role in spirituality care due to society pressures, misinformation of religious practices, and wholehearted fear of causing friction or tension with the patient. We all know that spirituality is a "touchy" subject and patient's can have very intense or reserved feelings about it. Spiritual topics can tear people apart just as quickly as it can bring people together, and it seems that nurses have chosen to stay out of the conversation to avoid any possibility of negativity. But lets go back to where we (Nurses) fit. Spiritual health is a part of patient-centered care. Spirituality is a part of patient health. Nurses need to be involved in this care planning for their patient-not just breezing over the question "Do you have any spiritual preferences that you would like carried out in the hospital?" But rather taking the time to connect with the patient to fully assess their spiritual wellness and determine if there is additional care that can be provided to meet their spiritual needs.
Let's take a step back and talk about why the split happened in the first place. Most of the disassociation between Nursing care and spiritual care began with the division between politics and religion. Politics and Religion have had a polarized divide for centuries and centuries long. And typically, in any setting, when you talk about politics or religion there are going to be some deep rooted disagreements. Nurses cannot and should not stand in the middle of this. However, somehow our professional practice became burdened with the issues of clients feelings about their government and their religion. The truth is that Nurses don't have to get involved in their patients political views or their religious practices (unless requested). We can steer clear of these subjects and stay on the topic of spirituality. Why spirituality? Well...spiritual health is a cornerstone of total healing and wellness. We know from our original teachings in Nursing school that spirituality is the foundation of every client's views on their morality and their values. Even deeper than that, spirituality helps the individual find significance in their lives purpose, their identity, and it is the birth place for deep self connection. The truth is that healing, from any illness, starts with the patients self will, their self worth, and their internal self-evaluation. Spirituality is deeply magnified in a patients health journey and their healing practice. Nurses should be a part of their client's spiritual health practices. Nurses should assess their clients spiritual beliefs, their needs, and daily practices. Do they meditate? Do they pray? Do they journal for daily gratitude? Asking questions like these, help nurses to establish the type of spiritual care the patient will require. It also helps to open up the assessment for resources and support systems that the patient may need while they are receiving care.
Even though we know that spirituality and religion are very different. We have also learned that they are closely related. And if your client has religious preferences & beliefs-then you can honor them as well. You can always start with assessing just what those needs are. Do they want a pastor present during their care journey? Do they need time to visit the in-patient chapel or receive prayer from a local priest? This is where the lines between spirituality and religion can become intertwined. However, if both of these practices are serving to improve your patients journey then be a part of it. So let's address the elephant in the room. What about when you (personally) don't agree with or don't relate to your client's spiritual practices, how do you provide spiritual care for that patient? Can you give quality spiritual care to a client that you are in utter disagreement with? Truthfully, the answer is quite complex and has some blurred lines. Nurses must take accountability for their role in the care journey of every patient and that starts with a self evaluation. Nurses must process their internal feelings, beliefs, and biases to ensure that they are not projecting this into client care. This is the initial and crucial step of spirituality care as well. Then the nurse needs to begin to investigate what the conflict is between the client's spiritual practice and the nurses beliefs. Is the patients spiritual practice "outdated" in some way? Is there spiritual practice odd (to you)? Or is their practice just completely opposite from yours. Maybe the client channels energy from crystals or recites mantras. Either way you have to get to the bottom of the problem and really determine if it is truly an issue or a bias. Spiritual practices that would be causes of notable concern would be practices that are "unhealthy", harmful to the client or nurse, physically demanding, disruptive to other patients, or conveying negativity. Then there is the inner intuition that nurses have. The inner sense or perception and inquiry. Maybe you sense negativity or "darkness" in their spiritual practice and you don't know how to identify it, you just know that you don't want to participate in it. Well here's the complexity of your Nursing role-defined. You're kind of always involved.....even when you don't want to be. The patient is in your care for the time that you are assigned to them and you may have to work to find common ground with them....so let's see what that looks like
FIRST: Assess. Perform that "lingering" self-bias assessment. Assess yourself first, ensure that your mind is open, that you are receptive to your client's needs first, and that you are willing to assist them in spiritual health.
SECOND: Just ask your patient. Ask your patient HOW you can help them? What do they need you to do? You would be surprised how many patients are very self reliant in their spirituality and most times they just need your support or help with resources.
THIRD: Be present. If they need you in that moment-then be there. If they ask for your hand in prayer-lend it...and bow your head too. Many times there is a dreaded sense of loneliness during the healing journey and patients do better spiritually when they feel that they are not alone on the journey
NEXT: Be honest. If your patient is asking you to participate in something that you absolutely cannot be a part of, then be honest with them about your conflict. Let them know that you will do your best to help find a different resource or avenue for them to get the help they need-even if the help isn't coming from you.
FINALLY: Seek help. Don't do spiritual care alone. Enlist the participation of the facility chaplain or spiritual advisor, your charge nurse, and family that is present with the patient. Many times there is someone else with resources and spiritual support that can assist you with providing quality spiritual care to your patient.
Ultimately, remember that this is a journey of the patient. It is not something that you need to internalize of take personal in anyway (good or bad). Just be the supportive vessel that acknowledges and recognizes your patients' need for spiritual care and wellness while healing. Know that spiritual care is a part of Nursing care. Know that you can and should be a significant part in spiritual healing for your patient and that your support is much needed in this area. Don't let your personal beliefs or biases become a barrier to your patient. And don't let society pressures and false information tear you away from helping your patient in this pivotal area of their care. I am a firm believer and can attest that spirituality and nursing can go together hand in hand in a positive way and I hope you will reconsider your role in providing spiritual care at the bedside.
Listen, implementing spiritual care into your nursing practice maybe difficulty for you to approach. You really need to talk with a nurse who has successfully incorporated spirituality practice into their bedside role. My Mentoring skills are designed to help you improve in your nursing career and reach your fullest professional potential.
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Happy SOARing!!!
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