"We believe in addressing the whole person: mind, body and spirit, and so much of the healing that occurs in the hospital setting is related to the individual's spiritual well-being." That's how Kathleen Penzes, MN, RN-BC, NEA-BC, executive director of women's services and nursing administration at St. Joseph Hospital of Orange, described the facility's mission of care, adding that "even though we're a Catholic organization, we look at religion not so much as conformation with an organized body of beliefs, but as part of the spiritual nature of human beings."
|PART OF THE MISSION: At St. Joseph Hospital of Orange, information about spirituality and ethics is incorporated into nursing orientation, and it's reviewed every year. Here, Kathleen Penzes, MN, RN-BC, NEA-BC (left), reviews patient information with Teresa Servin, NA, and Angela Pagnanelli, RN. courtesy Jason Wallis Photographer, Wallis Photo LLC
Nurses play a key role in respecting the religious diversity among patients and families within Penzes' faith-based organization. "It's part of our nursing background to honor the spirituality of our patients, so some of the initial nursing assessment questions address religious beliefs and preferences," she said. "We do have priests available, and can offer daily Communion to our Catholic patients. But for those of our patients who are not Catholic, we have chaplains who visit as representatives of our organization focusing on spirituality."
Over the years, Penzes has found people's religious beliefs truly come into play when they're ill or dying. "We will make whatever accommodations they request to honor those beliefs," she said. "Some of our patients have an end-of-life plan, analogous to the birth plans some families develop when they're expecting a child, and those plans may involve bringing extra people into the clinical setting. While we typically limit visitors, particularly in times of pandemics like H1N1, we flex those rules at the beginning and end of life."
When end-of-life rituals involve large gatherings, music or chanting, Penzes and her colleagues do what they can to minimize disruption to other patients. "While it can be a challenge in settings such as critical care to make accommodations, our nurses understand they can make exceptions to the guidelines to honor their patients' religious beliefs," she acknowledged. "The bedside nurse will identify a need or request and bring it forward to the charge nurse to develop a reasonable plan."
Education & Support
St. Joseph Hospital of Orange has a strong infrastructure in place to ensure employees understand and respect the spiritual needs of patients and their loved ones. "We incorporate information about spirituality and ethics into our nursing orientation, and it's reviewed every year in mandated online educational modules," Penzes said. "We acknowledge the need to be attuned to how people want to leave this life, to identify and respect the rituals that will comfort both patients and families, and to accommodate the friends, family members and spiritual representatives who should be involved in those practices. We also let our new nurses know representatives from our own spiritual care department are there to support them and answer their questions."
Chaplains at St. Joseph bring a wealth of knowledge about other religions, as well as access to a wide variety of community resources for patients and families. "They can identify representatives from various faiths; for example, they know who to contact if a patient is a Mennonite and wants a visit from someone with that religious background," Penzes said.
Penzes described the way religion influences ethical decision-making. "There are always new ethical issues arising in healthcare, and many of those issues center on religious beliefs, customs or practices," she said. "We make a great effort to stay aware of those ethical issues, discuss them openly within our ethics forums, and pay attention to the spiritual and ethical concerns of our patients and their loved ones."
Every nursing unit has specially trained nurses known as "ethics aces" who are knowledgeable about Catholic religious directives as well as topics related to other faith-based groups. "We also have a hospital-wide ethics committee, and the expertise of an ethicist who can help us make sound decisions," Penzes said.
|ALL EARS: Buddhawan "Angel" Naayuddhaya, BSN, RN, believes it's important to take time to listen to her patients so she can help them better understand the care they are receiving. courtesy Sutter General Hosptial
Buddhawan "Angel" Naayuddhaya, BSN, RN, a staff nurse on an orthopedic med/surg unit at Sutter General Hospital in Sacramento and chairperson of her unit's Partnership Council, also believes her colleagues do a great job of honoring religious diversity. "All Sutter nurses are very good at having compassion for patients and honoring their religious beliefs," she said. "Whenever we have a patient from an Asian culture, for example, we make use of the resources available through our hospital chaplains."
As a practicing Buddhist, Naayuddhaya is aware of both similarities and differences within the population she serves. "Most of our patients believe in God, or they believe in a spirit, and we want them to feel comfortable with that belief when we're caring for them," she said. "It's important for us as nurses to understand the way each person expresses his beliefs. For example, people who follow Buddhism don't like to be treated aggressively - they like to be treated gently."
Aware that many Buddhist patients may not want to follow a doctor's advice right away, Naayuddhaya has developed an effective way of helping those she cares for. "I take care to listen to what he has to say," she said. "I also listen to what the doctor tells the patient, rephrase it and reinforce it when appropriate, and answer any questions the patient may have. When I follow this approach, the patient can better understand the value of the treatment, and will be more willing to follow his doctor's recommendations."
Naayuddhaya believes that sincerity and caring can help overcome differences based on religious beliefs. "Buddha taught all people to always do things in moderation; not too loose and not too tight," she said. "Because of my religious background, this advice is from my heart and patients can tell I believe it and follow this plan of action in my own life. When I talk with them, I always have eye contact so they'll know I'm talking from my heart."
Nurses are in a good position to integrate information about spiritual issues into the overall care of the patient. "It's important to respect a patient's religious beliefs, whether those are Christian, Buddhist or something else," Naayuddhaya said. "When a patient comes to our unit, I don't approach him with an attitude of 'I'm a nurse and can tell you what to do.' Instead, I listen to my patients so I can learn about their beliefs and how those beliefs influence their disease and their care. Healthcare needs to be a team effort between the physician, nurse, patient, family members and other healthcare professionals. We can't help our patients without including them on our team."
Sandy Keefe is a frequent contributor to ADVANCE.