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Whether they call it faith, inspiration or just the
human touch, nurses are finding it more difficult to
stay connected to the spiritual roots of the profession.
The growing shortage of RNs in hospitals leaves those
who remain by the bedside little time to dispense the
kind of patient care and comfort that inspired many
to become nurse healers in the first place.
Lack of time and a model of medical care that separates
spirituality from science are forces nurses say are
pulling them away from their traditional healing mission.
Even though most hospitals have chaplain services for
their patients, no one expects a nurse to provide that
kind of emotional and spiritual support, said Roberta
Bube, RN, PHN, a parish nurse who is about to return
to hospital nursing part time at the Marion Medical
Center in Santa Maria, Calif.
"You have to address mind, body and spirit,"
Bube said. "I always found time to do it [in a
hospital]. I did have to be cautious. I'd have to do
it quietly. Everybody's beliefs are different."
A startling 89 percent of RNs who responded to a survey
sponsored by NurseWeek and the American Organization
of Nurse Executives said the nursing shortage affects
the amount of time they have to spend with patients.
Another 68 percent of the 4,108 respondents said they've
seen the number of patients assigned to each nurse grow
in the last year, according to the survey released in
April.
Despite this workplace time crunch, nurses need to
find time to nurture the spiritual needs of their patients,
said Jan Ingram, RN, clinical coordinator of the parish
nurse program at Saint Francis Medical Center in Santa
Barbara, Calif. "Whether you're giving them a sponge
bath or putting them on the commode, if you're really
there with them-mindfully present-that is a spiritual
action," Ingram said.
"It's not like you have to be there for 20 minutes
and put down your clipboard and talk about Christ."
Some nurses say time isn't the only issue. Kay McVay,
RN, president of the California Nurses Association,
said she isn't a religious person, but like many nurses
she views her profession as a higher calling. Today's
highly technical health care environment downplays that
aspect of nursing, she said, and that is one of the
developments that is driving nurses away from the profession.
McVay is not the only one drawing a connection between
job dissatisfaction and the withering spiritual roots
of nursing, either.
"There need to be some changes in the health care
system to provide time to address these spiritual issues
of patients and spiritual issues of nurses themselves,"
said Harold Koenig, MD, MH.Sc., RN, an associate professor
of medicine and psychiatry at Duke University Medical
Center who studies the connection between spirituality
and health.
Most people have some religious or broader spiritual
foundation in their lives, he said, and when they are
undergoing medical treatment, health care professionals
shouldn't ignore that dimension of their care.
Koenig, who founded Duke's Center for the Study of
Religion, Spirituality and Health, said hundreds of
research studies have documented a connection between
patients' spiritual beliefs and positive outcomes. Through
his own research, he said he has found that patients
who pray have better outcomes. From a physician's standpoint,
he said, recognizing a patient's beliefs increases trust.
"I've seen patients melt in my office when I've
offered to pray with them," he said.
Drawing a line between a patient's spiritual needs
and medical needs doesn't make sense, even in secular
institutions, he said. Koenig has written an article
for the Journal of the American Medical Association
that calls for physicians to incorporate a spiritual
inventory into each patient's care. All physicians and
nurses should do this regardless of whether they work
in a faith-affiliated hospital, he said.
At the least, a caregiver needs to know how someone's
religious beliefs might affect end-of-life and emergency
procedures.
Koenig recognizes that spiritual nurturing can add
>> an extra responsibility to a nurse's already
hectic work pace. In the interest of quality care, hospitals
need to make time for it, he said.
"In the long run, good care is the cheapest medical
care you can give," Koenig said.
Even in religious-affiliated hospitals where spirituality
is encouraged, the rapid pace of modern health care
can overtake spiritual caregiving. But building the
spiritual connections between nurse and patient doesn't
always take much extra time, said Sister Molly Nicholson,
vice president of ministry and spirituality at St. Rose
Dominican Hospital in Henderson, Nev.
Nicholson, who has a master's in pastoral care and
psychology, encourages nurses to make those human connections
with patients. Sometimes it's just a little thing, she
said, such as asking patients if there's anything else
she can do for them as she leaves the room.
"We believe in the healing of the body, mind and
soul," Nicholson said. "That's part of the
training for all our staff."
Hospitals such as St. Rose are continuing a long tradition
of marrying faith and healing. Some of the earliest
nurses came from religious societies such as the Dominican
order that founded St. Rose.
Historically, healing and religion grew out of the
same faith-based traditions. From the Middle Ages, the
old, sick and dying looked to religious practitioners
for comfort. When nuns opened hospitals, those institutions
became the training ground for nurses. With the development
of modern science, medicine and religion took separate
paths. Gradually, nursing preparation moved into university
settings, and government agencies assumed responsibility
for licensing and oversight.
But many hospitals and health care systems in the United
States owe their existence to orders of religious women.
St. Rose began in 1942 as a federally operated medical
center for workers from the Las Vegas-area magnesium
mines. Dominican sisters from Michigan took over the
hospital in 1947, turning it into a Catholic nonprofit
institution. Nuns became the administrators and the
nurses.
In the last 55 years, the center has grown to two campuses,
the 138-bed Rose de Lima campus and a 3-year-old, 142-bed
Siena campus. In 1988, the Adrian Dominican congregation
that founded St. Rose joined Catholic Healthcare West,
which runs medical centers in California, Nevada and
Arizona.
As in most U.S. Catholic hospitals, nuns in crisp,
white nursing habits no longer fill the corridors and
operating rooms. Today, St. Rose has seven nuns on staff,
but none are RNs. Sisterhood, like the nursing profession,
faces a growing shortage of new members. Yet the Nevada
hospital anchors its health care philosophies to the
spiritual foundation built by the Dominican sisters.
Nicholson holds training sessions for the nurses and
other staff members to address workplace spirituality
and how it comes across to patients and their families.
Everyone is spiritual, if not religious, Nicholson said,
and at St. Rose, that concept applies to both patients
and employees.
"Nurses are very altruistic," Nicholson said.
"They're there to administer to others. I try to
point out to them how they can minister to themselves."
St. Rose, like a growing number of hospitals, offers
RNs another outlet for their spiritual cravings through
a parish nurse program.
The Health Ministries Association, the professional
association for parish nurses, estimates that 6,000
to 10,000 RNs are trained in parish nursing in the United
States. Interest in this alternative to traditional
nursing is booming, said Lois Peacock, RN, an association
member who ran parish nurse training courses in the
San Francisco Bay Area for 10 years.
Parish nurses, who function either as paid part-time
RNs or as volunteers, provide congregations with services
such as health screenings, education and prevention
programs, home visits to the sick and elderly and community
resource referrals. They make home visits when someone
is discharged from a hospital. They explain physicians'
orders and after-care-and they follow up with return
visits, sometimes spending years working with the same
patients.
Those connected with the parish nurse movement say
this is the kind of work that first drew them to the
nursing profession.
Candy Montalvo, RN, became a parish nurse at Christ
the King Lutheran Church in Fremont, Calif., as a way
to combine her faith and nursing skills.
"In a hospital or clinic setting, we don't have
the time to do that, or the management frowns on it,"
Montalvo said. "You don't feel comfortable doing
it."
Montalvo worked in hospital and clinic settings before
turning to parish nursing. "I definitely do not
miss hospital work at all," she said. "It's
too busy. It's too technical. I didn't have enough time
to spend with patients. When I make a home visit, I'm
there for an hour. There's no time in the hospital where
I could have sat down with one person for an hour."
Most of the parish nurses are taking up this mission
later in their careers. They've worked in hospitals
and clinics and want another dimension to their daily
work. But what about young nurses just starting careers
and those who want to work in secular settings?
According to Madeline Wake, Ph.D., RN, FAAN, dean at
Marquette University College of Nursing, students learn
of the role spiritual beliefs play in healing.
As a Jesuit university, Marquette doesn't have to hide
its spiritual connection, Wake said, yet not all nursing
students will work in faith-affiliated hospitals when
they graduate. "We teach our students to take their
cues from client needs," Wake said. "If a
health care institution does not respect patient needs,
that's not good health care.
The program places students for clinical training in
80 hospitals in the Milwaukee area, Wake said, and there's
never been a problem with the nonreligious hospitals.
A nurse has a responsibility to recognize human spirituality,
said Dorel Harms, MHA, RN, vice president for professional
services at the California Healthcare Association, the
statewide hospital group. Nurses are so busy, she said,
and any time spent on nonscientific activity has to
take a backseat. But nurses still can be effective from
a spiritual standpoint.
"Nursing is an art with a scientific foundation.
It's based on trust," Harms said.
"Just like in life, you have to be balanced. You
can't base everything on science."
Contact
Donna Hemmila at dhemmila@prodigy.net.
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