The mission of nursing service organizations, be they acute, home or long-term care, is to provide holistic care that meets patients' individual needs. The conceptual framework of most nursing school curricula these days is based on a holistic care model--often a blend of several nursing theories. In recent years there has been a plethora of research linking the mind-body-spirit connection to disease and its prevention.
Spiritual care has always been an integral part of nursing since Florence Nightingale espoused its importance. However, often over the years, physical and psychosocial needs superseded the spiritual ones when planning a patient's care.
Today, meeting patients' spiritual needs is a requirement of the Joint Commission on Accreditation of Healthcare Organizations, and the North American Nursing Diagnosis Association lists "spiritual distress" as a nursing diagnosis.
EXPLORING YOUR OWN SPIRITUALITY
Unfortunately, for reasons discussed below, many nurses fall short of providing spiritual care. I've heard nurses express their inadequacies saying, "I'm not a religious person and I don't know anything about the patient's religion." Statements such as this often indicate that a nurse needs guidance in recognizing her own spirituality.
As you read on, I think the journey metaphor will be helpful in exploring your patients' spirituality--and your own.
Certainly, organized religion and its practices are expressions of spirituality. But, spirituality goes beyond religion. It includes the individual's beliefs, expressions of these beliefs, how the person relates to himself and others, his world, a greater power--and how he perceives the meaning of life and death. During illness and stressful experiences, a person may challenge, deny or have a need to reinforce these beliefs. During these times, the care and support a nurse provides are invaluable.
STRONG IN MIND AND BODY--WEAK IN SPIRIT
In Kathy Wright's article, "Professional, Ethical and Legal Implications for Spiritual Care in Nursing," (Image: Journal of Nursing Scholarship, 30(1), 1998), the author concedes that spirituality in nursing practice is lacking. "Nurses have historically embraced a holistic approach to care...However, despite this position, spiritual care largely remains a neglected focus of contemporary nursing practice in the U.S.A.," she concluded.
"Despite a long history of religious influence and the recognition of humans as spiritual beings, many nurses have traditionally been reluctant to develop and use skills in providing spiritual care," wrote Wright. Nurses cite lack of education in spiritual care, fear of invading a person's privacy, lack of time and lack of awareness of one's own spirituality as the primary reasons for this deficiency, according to Wright.
"In most cases, we do a good job of addressing the mind and body, but we often leave the spiritual part out," commented Edie Hanzlik, MSN, RN, C, assistant professor, Gwynedd-Mercy College, School of Nursing, Gwynedd Valley, PA.
In addition to teaching community nursing to undergraduates, Hanzlik teaches parish nursing at the college as a continuing education course for RNs.
"I approach spiritual care as a journey. In essence, the nurse develops a relationship with an individual and shares with him that we're all on a journey--and have stories to tell.
"The nurse helps to enhance the person's movement along this spiritual path. Many times nurses are the ones left with patients after they've been told some devastating information," summarized Hanzlik.
"When patients are at this stage of their lives, they express themselves; sometimes, to the deepest core of themselves--their spirituality. They share how this experience affects them--how they perceive the meaning and purpose of their lives, their perception of suffering and death," detailed Hanzlik.
"Spiritual care is the nurse connecting with the individual on a level not specifically religious, but one where the nurse and the patient 'touch' each other; however, not necessarily physically." This may include the patient asking the nurse to pray with him if she (the nurse) feels comfortable with this. And, it includes the nurse promoting realistic hope in the patient.
"When a patient shares this information with the nurse, it is a privilege and should be regarded by the nurse as a privilege," emphasized Hanzlik.
Assisting a patient to explore and work through these deep thoughts and feelings requires a nurse who can listen responsively. She can then provide the patient the opportunity to reflect upon his joys, sadness, conflicts--a wonderful growth experience for the patient and the nurse, according to Hanzlik.
TAKE ADVANTAGE OF OPPORTUNITIES
At Gwynedd-Mercy, as in most nursing programs, spiritual care is discussed throughout the curriculum, but as of now it is not fully integrated. For example, Hanzlik noted that when students have hospice and home care experience, there is emphasis on the concept of spirituality. And, when a student has a clinical experience where she "touches" a patient and is able to overcome her own barriers, discussing the event can be an excellent growth opportunity for the student, she added.
Hanzlik's example brought back memories of my days instructing senior students on the burn and hematology units at Los Angeles County-University of Southern California Medical Center. During the six years I was there, we had multiple deaths on both units several times--at the same time. In these instances, I would call upon the hospital chaplain to co-lead a post-conference. We became a good tag team. Amid shared tears and a safe place to discuss their own spirituality, these sessions provided spiritual growth for the students--and the facilitators.
In Part 2, meet the Rev. Robert Taylor, RN, ordained minister and nurse, who will share how he incorporates spirituality into clinical practice.
Kay Bensing is a senior staff nurse consultant to ADVANCE.