By providing compassionate care, the nurse directly impacts the patient’s physical and emotional needs, but holistic care also involves caring for the spirit. But for some of you, spiritual care may conjure up images and expectations of praying with patients and going way out of our comfort zone. Though spiritual care may include prayer it is actually so much more. The essence of spiritual care is caring and serving the whole person: the physical, emotional, social, and spiritual aspects of their being (1). Nurse presence is an essential component to spiritual care as the nurse engages and assesses the “entire” patient with the “entire” nurse (1). It is important to note the distinction between spirituality and religion to promote our understanding of spiritual care.
Spirituality is a broader concept than religion. It represents the innate human beings search for the meaning and purpose in life. Religion is a set of beliefs, texts, and other practices that a community shares in its pursuit of relationship with God or that which is transcendent. Because HOPE and MEANING are key components of spirituality, spiritual care is helping a patient to find/make MEANING out of his/her experience and find HOPE. Practical interventions that we can utilize to facilitate this for a patient include listening, encouraging the expression of feelings, compassionate presence, open-ended questions, instilling hope, and prayer (1).
Though spiritual care is clearly within the nurse’s scope of practice, I find that most students as well as nurses in practice are uncomfortable with this responsibility. Contributing factors to this discomfort for some may include the dominant physical/medical model in healthcare, secular-humanistic worldview of educational and healthcare institutions as well as a lack of emphasis on spiritual care in nursing education (87 percent of programs do not have specific content on how to practically incorporate spiritual care in practice!)(1). I have observed that those that are most comfortable with spiritual care find their own faith and spiritual traditions personally meaningful and relevant. When it comes to spirituality you cannot give anything to others if you do not have something within to give. But regardless of where you are in your faith journey, I want to encourage you to embrace this responsibility in some very practical and non-threatening ways so that you can holistically support and care for your patients.
A practical approach to providing holistic spiritual care in your practice is to recapture the perspective that all that you do for your patient can be an act of spiritual care. Instead of compartmentalizing your patient care as “tasks” and spiritual care as something you will do when you have the time, everything you do for your patient (who you view holistically) can become a demonstration of spiritual care. For example, taking a set of vital signs becomes an opportunity for presence and spiritual assessment. You can further intentionalize spiritual care by thinking with every interaction, “What are this patient’s needs, fears, anxieties, or questions?” Every interaction is filled with meaning as you engage the “entire” patient with yourself wholly engaged (1).
In my own practice I have found it helpful to pay close attention to what is in my patient’s room. If there is a Bible or other material of a spiritual nature, if/when appropriate, engage the patient regarding their faith and current illness. For example, I recently cared for a patient who had a Bible in his room. I asked, “Do you have a favorite passage, and if so would you like me to read it to you?” He wanted me to read the Twenty-Third Psalm: “The Lord is my shepherd I shall not want…” He closed his eyes and was clearly at peace as I read this to him. He thanked me afterwards and asked if I would pray for him. After a short prayer he fell asleep. This took only a couple of minutes, but it clearly ministered and cared for his spirit. I have found that the LITTLE THINGS done at the bedside such as spiritual care are often BIG THINGS to the patient and make a difference to their emotional, spiritual, and even physical well-being.
If you are comfortable with including prayer as part of your care, don’t forget that you always have the option to pray FOR your patients. You can do this alone as you provide care, or if you have determined that spirituality is important to your patient, offer to pray for and with them. I have yet to be turned down after thirty years of clinical practice by this request when I have sensed or assessed that this would be meaningful to my patient!
If your patient has definite spiritual concerns or spiritual distress, do not hesitate to contact or make a referral for the chaplain. But the nurse can also implement these spiritual assessment questions to provide support in the present as well as provide documentation in the medical record:
- Are you connected with a faith community? What do you appreciate about this community?
- What is your source of strength, peace, faith, hope, and worth?
- What spiritual practices are important to you?
- How has your health problem affected your spiritual beliefs?
- What can I do to support your faith?
- How do your beliefs help you cope with suffering and illness? (2)
1. Murphy, L.S., & Walker, M.S. (2013). Spirit-guided care: Christian nursing for the whole person, Journal of Christian Nursing, 30(3), 144-152.
2. Nurses Christian Fellowship Spiritual Care Guide. NCF-jcn.org. Retrieved from http://ncf-jcn.org/sites/ncf/files/uploaded/outreach/spiritualcarecard.pdf
The following is an excerpt from my new book: THINK Like a Nurse: Practical Preparation for Professional Practice/chapter 1: Foundation: The “Art” of Nursing