NurseWeek: A Spirited Approach: Nurses and chaplains team up to provide pastoral care for patients’ needs

A spirited approach
Nurses and chaplains team up to provide pastoral care for patients’ needs
By Diane Sussman
August 28, 2000

Although the line of demarcation between religion and medicine in America remains firm, there are more points of intersection. Many nurses appreciate the opportunity to join in a patient’s spiritual care.

Illustration: Artville


	You've read the article. Now tell us what you think. Related sites Hospital Chaplain's Ministry of America Joint Commission on Accreditation of Healthcare Organizations Soul support Because they work with the sick and dying, nurses often find themselves called upon to minister to a patient’s spiritual needs. At the same time, they have concerns about the appropriateness of such activities, as well as questions on how to proceed. Russ Myers, chaplain with United Hospital in St. Paul, Minn., offered this perspective in the Aug. 7 issue of Update, a weekly newsletter published by United Hospital. Reprinted with permission. Q: Can spiritual care be provided by someone other than a chaplain? What about nurses or doctors praying with patients? A: Chaplains are not the exclusive providers of spiritual care. Much of the spiritual and religious support given to patients and their families comes from other people, including community clergy, family and friends of patients, volunteers who represent different faith communities or congregations, and others. Hospital staff also sometimes address the spiritual needs of patients. Staff who are comfortable praying with patients or offering other kinds of spiritual support are asked to keep these things in mind: Keep your focus on the patient and family’s needs and beliefs, rather than on your own. It may be helpful to verify the religious preference information on the chart to make sure it is current. Rather than guessing or assuming, ask the patient or family their religious preference and if they are affiliated with a congregation. Ask the patient and family how you can respect and support their beliefs and traditions. Keep in mind that different members of the same family may observe different religions. Refrain from proselytizing or evangelizing. If a patient asks you about your own faith, it is acceptable to engage in some general conversation about your beliefs. However, be aware of the boundaries and your own ethical responsibilities to patients and families. Your sensitivity in this area is critical. If you are not comfortable addressing spiritual issues with patients, it is always an option to request a chaplain visit.

It was the typical aftermath of a failed resuscitation attempt: demoralized nurses and physicians, a room littered with tubes and vials, family members anxiously waiting for news. Although there was no precedent for it, Chaplain Dick Sellers remembers it as the time a priest walked in uninvited and said a prayer for the patient, his family and for those who had tried to save him.

"It ended up being the right thing to do," said Sellers, spiritual director of Allina Metro Hospitals in Minneapolis. "With that prayer, he converted something that was a failure into something with meaning. The nurses and staff told him it helped."

No atheist foxholes
Check almost any hospital, hospice or nursing home these days and you are likely to find a dizzying round of treatments, medications and tests punctuated by the hushed tones and unhurried moments of spiritual conversation and prayer. Although the line of demarcation between religion and medicine in America remains firm, there are more points of intersection.

"There’s much more understanding that this is a clear component of healing," Sellers said. "I think patients and families – and nurses, too, because they are so close to it – have always known this. It’s just administrators and doctors who were slow to catch on.

"There aren’t very many atheist foxholes," he said.

Or ICUs or oncology beds, research suggests. In a two-year study completed last year, researchers from the department of oncology at the University Hospital of Tromso, Norway, found that 90 percent of cancer patients have a deep interest in matters of faith, 85 percent believe in God and 75 percent pray.

Interviewers concluded that the topic should be addressed among patients with advanced disease, provided caregivers approach the subject respectfully and are careful not to alarm patients with references to death.

Administrators may have been slow to recognize the frequency and debilitating aspects of spiritual distress, but they are making up for lost time.

Granted, they have been given a push by the powerful Joint Commission on Accreditation of Healthcare Organizations, which since 1991 has required health care facilities to make pastoral care available to all patients who request it, said Pat Staten, associate director of standards interpretation for the commission.

How organizations provide that care is flexible, Staten said. "It doesn’t matter what type of program they have as long as the wishes and rights of the patient are granted," Staten said. "It can be as simple as having a chaplain on-call or arranging for the patient’s outside minister to come and visit."

Role uncertainty
But even in hospitals with a full-time spiritual care staff, spiritual care can fall through the cracks – and onto the shoulders of nurses.

A study of oncologists and oncology nurses conducted by the Walther Cancer Institute in Indianapolis and published in the September-October issue of Psychooncology found that a substantial portion of both professions identified themselves as primarily responsible for addressing spiritual distress in their setting. At the same time, 85 percent believed that, ideally, a chaplain should address such issues.

Although both a lack of confidence and role uncertainty played a part in preventing nurses from attending to patients’ spiritual needs, the most significant factor was a lack of time.

"Most of the time you are so busy doing physical stuff you have to ignore the patient’s emotional and spiritual needs," Chaplain Alice Kirkpatrick said. "Sometimes, it seems like the chaplain is the only one with the time to sit with the patient."

Kirkpatrick spent five years working as a bedside nurse at hospitals and drug rehabilitation centers in Orange County before becoming a chaplain at Riverside County (Calif.) Regional Medical Center.

"It’s great to have a medical background," she said. "You have a much better idea of what nurses and doctors are going through. I often thank God for the nurses and doctors and ask God to help guide them in diagnosis or treatment."

Many nurses appreciate the opportunity to join in a patient’s spiritual care, which has opened up over the years.

"What has expanded is an interdisciplinary approach to spiritual care," Sellers said. "It’s moved from the semiretired, hand-holding ministry to working as a team, integrating all the psychological, medical, spiritual and emotional aspects of care."

Nurses who would like to pray with families of patients who could not be saved may grope for words during those somber moments. For those times, Chaplain Dick Sellers has developed this prayer:

A prayer

Creator God/Loving Spirit.

Our lives are a gift, which comes from and returns to you in ways we do not understand.

We have thanks for (name) and for all that his/her life has been.

Receive (name) into your loving care.

We pray for those who have loved (name) that they may find comfort in their loss.

Thank you for all those who have cared for (name) through his/her life and for those here who have tried to save his/her life.

May we depart from this place in peace with the sure knowledge that we have done what we could do and that we can now entrust (name) to your care.

Amen.