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Spiritual Care in Nursing

Nurses' attitude towards spirituality and how it benefits their patients

Spirituality in health care is "that part of person that gives meaning and purpose to the person's life. Belief in a higher power that may inspire hope, seek resolution, and transcend physical and conscious constraints." 1

Spiritual care in nursing is an important part of overall healthcare. Although nurses may recognize the value of spirituality to their patients, many are unsure of how to best address those needs. Nurse researchers led by Christina Canfield, RN, MSN, ACNS-BC, CCRN-E, a clinical nurse specialist at eHospital, Cleveland Clinic studied nurses' definitions of spirituality and their comfort levels in providing spiritual care to patients.

Debi Taylor, RN, Sutter Tracy Community Hospital, Tracy, Calif., one of the study's co-authors, found it difficult to provide spiritual care without a guiding framework.

What is Spirituality?
To arrive at a working definition of spiritual care for their study, Taylor and another nurse interviewed 30 bedside nurses who worked in critical care at a large teaching hospital. The majority of interview subjects has been critical care nurses for four years or less; they also tended to be female, in their 20's, and hold a BSN as their highest level of education.2

 They asked the nurses:

  •  "Could you tell me about a time when you interacted with a patient who really needed some spiritual support or attention?"
  •  "Please describe your personal definition of spirituality?"
  • "How do you see the connection between religion and spirituality?"
  • "Could you talk to me about your own comfort in providing spiritual care to critically ill patients?"3

The nurse investigators also reviewed existing literature on the topic of spirituality in healthcare and saw patterns emerge.  Previous research had found that spiritual care needs to be addressed among all patients. In fact, a Press Ganey study revealed hospitalized patients placed attention to their emotional needs as a top priority. Other researchers determined spiritual training for nurses was necessary to improve the nurses' competence in addressing the need in patients.1

One nurse in the study commented: "I think everyone's definition (of spirituality) would be completely different . I don't know. Like a background that no one can really explain."1holding hands

"As themes emerge, we created a definition," Taylor said. The resulting definition of spirituality in healthcare is quoted in the opening paragraph of this article.

Nurses' Insights into Spirituality
Canfield remarked, "Nurses were very open, candid and emotional. It was cathartic for them." The nurses in the study had the desire to provide spiritual care to their patients, but did not always know how to go about it.  75% of the nurses interviewed expressed at least some degree of comfort at offering critically ill patients spiritual care.

"Many of our interviews indicated a belief in a higher power and that belief gives hope," explained Taylor. One nurse explained it like this:

"If the family is praying, you can stand there quietly and offer, show your support, you know, you don't have . to be afraid to let them know that . you do believe in something and . you're not just about the technical stuff."1

 "When we talked to nurses, they commented that spirituality and religion were two different things. Religion was one way to express spirituality, but not the only way," Taylor remarked. One research subject described the difference as follows:

"I feel like religion is more of a set, a creed and structure and also a feeling of belonging to a people of the similar belief system and spirituality is your own internal connection."1

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That finding was particularly surprising and thought provoking to the researchers. For both nurses and patients, spirituality transcends conscious constraints on the individual.

"Nurses are often the first people to identify the need," noted Canfield.  The question then becomes: "What do you do with it from there?" 

Holistic Healing
She continued, "If we just care for patient's body, we miss opportunities." If nurses want provide holistic care, than addressing spirituality is an obligation. Simply by putting the patient at the center of the experience, they recognize the value of spirituality.

Literature reviews and gaining knowledge on the growing field of spiritual care interventions is one way nurses can educate themselves. They can also make themselves aware of resources at their hospitals. Working with a chaplain can uncover different ways to meet spiritual needs. Knowing where to find resources, like spiritual assessment questions and diversity toolkits before they need them, is a major help to the nurses.

One way nurses can offer spiritual care is to offer their presence and be purposeful. "When done doing technical care for patients, be emotionally present. Create an environment where patient feels comfortable to talk," said Canfield.

Many of the nurses in the study used offering as a way to connect with their patients in need. Offering is extending the opportunity to pray, listen to the patients' concerns, hold their hand, or simply be there. One subject was quoted in the study:

"Uh, open conversation I feel like is beneficial. To just to ask them how they are feeling, what's going on, um, how they're coping. I mean, we are lucky to have consults with spiritual priest or whatever you want to call them to come up and talk to families, but, I found that just being a presence, um, and giving them open opportunity to talk is the best way that I found to help them cope through a situation like that."1

Taylor summed up many of the study's findings. "Assessing the mind, the body and the soul necessitates the care of spiritual interventions."

Danielle Bullen Love is on staff at ADVANCE. Contact: dbullen@advanceweb.com

References

1.Canfield C et. al. Critical Care Nurses' Perceived Need for Guidance in Addressing Spirituality in Critically Ill Patients. American Journal of Critical Care. May 2016. 25 (3). 206-11.

2. Table 1. Critical Care Nurses' Perceived Need for Guidance in Addressing Spirituality in Critically Ill Patients  http://ajcc.aacnjournals.org/content/25/3/206/T1.expansion.html

3.Table 2. Critical Care Nurses' Perceived Need for Guidance in Addressing Spirituality in Critically Ill Patients  http://ajcc.aacnjournals.org/content/25/3/206/T2.expansion.html


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I have been a Critical Care RN for many years. I have worked in IL, OH, IN and MI. I've been staff in faith based and big corporate hospitals. I have found that Faith based hospitals, even though that is not a requirement of patients or staff, use a holistic approach to patient care, making spiritual care easier and a regular part of patient care. If the patient is not whole in mind and spirit, the body won't get whole either. When patient care is focused on the illness, healing is harder and takes longer, In my opinion...

Diana Schilling,  RNNovember 27, 2016
Ann Arbor, MI



Worked in ICU/CCU for 7 yrs. and many other areas of nursing. Encouraging and valuing with respect the pt's spiritual beliefs is essential for their comfort. As a young nurse, I was not as comfortable as I became with age. We are living in an age that has progressed in its acceptance of spiritual belief of soul life after death. Elizabeth Kubler Ross provided much info on subject and there is much written on subject. Nurse needs to keep an open mind and listen to their pts.

Dorothy Ryan,  RN,  RetiredNovember 03, 2016
Retired, SC



I love this article. We need more info like it to help nurses learn and feel more comfortable about sharing the spiritual needs of our patients and their families. Here where I work this kind of holistic care is encouraged and is stated in our I CARE Values.

Gretchen Rankin,  RN,  HospitalNovember 03, 2016
Houston, TX



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