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Shift from the self

In the postmodern era, individuals have begun to focus more on their place in the community and less on themselves, Kuepfer said. All people, including agnostics and atheists, ask how they can make meaning out of their lives and have the need to connect with something bigger than themselves, he said.

Along with a shift in individuals’ attitudes has come a shift in the duties of hospital chaplains. Chaplains may have focused exclusively on providing religious rites for patients and their families 10 or 15 years ago, Kuepfer said, but now they focus more on empowering hospital staff members to serve the community.

Through the “Because We Care” team, Kuepfer, along with health care professionals in the pediatrics unit at Sioux Valley Children’s Hospital, try to meet staff members’ spiritual needs and educate them on how to talk to patients about spirituality.

In 2002, team member Val Lentz, RN, a case manager at the children’s hospital, examined pediatric nurses’ responses to grief and loss. She did this as part of her bachelor’s degree program in management at the University of Sioux Falls. Her survey revealed that nurses generally don’t feel competent when caring for the spiritual and emotional needs of patients and their families. The nurses believed they needed a strong base of support and that they needed to learn how to take better care of themselves before they could take care of others.

After Lentz presented the results to her co-workers, the pediatrics unit worked to integrate spirituality better into nursing care. The unit has set up a Because We Care board, where staff members post what’s going on in their lives so they can offer each other support. The unit also has debriefing sessions after patients die, and Kuepfer offers monthly “chats with the chaplain” for unit staff members.

To learn how to address patients’ spiritual needs, staff members attend a discussion run by Kuepfer and Carol Cressman, RN, a critical care nurse in the children’s hospital intensive care unit who is also a part of the Because We Care team. The discussion focuses on coping with children’s deaths and how to talk to their family members about it.

Sioux Valley health care workers also have focused on meeting patients’ spiritual needs right before death. The health care workers have done this through the bereavement program, which Cressman helped create in 1987. Through the program, medical staff members have referred family members to guidance counselors and religious officials. Staff members also have honored families’ requests to have the appropriate religious official present during the child’s death.

Families have told Cressman that the bereavement program has made a difference. “It brings home how very, very important your role as a nurse is,” Cressman said.

Some nurses contend that patients’ spiritual needs have increased in recent years. Although Marr believes that Sept. 11 has prompted patients to ask more theological questions and wonder more about the meaning of life, Lentz attributes the heightened spirituality to the rise in the number of children with chronic medical needs. The medical field has improved so much in caring for babies who are chronically ill that babies who didn’t used to survive now survive into childhood, she said.

Cressman said that nurses have focused more on spirituality because of the recent emphasis on hospice and palliative care. She also believes it may have to do with the aging nursing workforce. Generally, as people get older, spirituality becomes more important to them, she said.

Through the years, Cressman has been able to integrate her spiritual skills more easily into her practice. She recalls last year, when she believes she helped a teenage cancer patient prepare for death.

“Does it hurt when your heart stops?” the girl asked her.

Cressman told the girl truthfully that she didn’t know. But she also assured her that children usually seem comfortable when they die and that medical professionals do everything they can to make sure patients are comfortable.

A few days later, as the girl died, the nurse believes she felt safe and comforted.

“It’s eye-opening to touch a heart and soul and reach that kind of connectedness,” Cressman said. “All I needed [right then] was my hands and heart. My technical skills as a nurse did not matter.”

Contact Rebecca Ray at rebeccar@nurseweek.com.