Spiritual Practice in Nursing
A child is suffering from the physical and emotional trauma of rape; a man was fixing his tire when a drunk driver ran him over, breaking his legs and collapsing both of his lungs; a mother was prescribed pain medication and is now hopelessly addicted to the drug; a soldier, returned from the U.S. war against the people of Iraq, has uncontrollable pain due to physical injuries, but cannot repress the memories of the horrors of the war which go well beyond his physical impairment.
For those devoted women (and men) in what is called “the ultimate care-giving profession,” nursing, each of the above scenarios are common experiences. As I enter the profession of health care management, I have, on numerous occasions been witness to instances where friends who were nurses, or students who I knew in nursing school, or friends of mine who need the care of a nurse, each in their own way felt the need to resort, in the course of treatment, to the question: “What is the meaning of this?” “Why did this happen to me?” “What message am I supposed to learn from this experience?”
It is the thesis of this study that the demand and the meeting of the demand for a spiritual practice in nursing has arisen from the conditions of ill-health specific to an ill social order. The dispensation of a spiritual practice in nursing has helped to address the seeming lack of meaning in the suffering of literally millions of people in this society, and has hence become a requirement of health care giving.
What is a Spiritual Practice in Nursing?
According to the Royal College of Nursing, spiritual care in nursing is that care which recognizes and responds to the needs of the human spirit in the face of trauma, ill health or sadness. This response can include the need for meaning, for self-worth, the need to express oneself, the need for faith support (perhaps religious rituals), or simply for a sensitive listener. “Spiritual care begins with encouraging human contact in compassionate relationship, and moves in whatever direction need requires” (2011).
Spiritual needs are recognized as including the need to love and be loved, to forgive and be forgiven, to hope, to trust, to be strengthened, to have relationships, to have meaning and purpose in life, and to transcend (Lemmer, 2005).
When nurses, or their patients, or nursing school courses, or hospital administrations suggest that the profession and provision of nursing have, as one of the elements of the practice, a spiritual component, each of them is speaking of addressing issues of the patient’s value system, belief system, particularly their sense of a power greater than medicine, greater than the doctor, more powerful than the insurance payments, etc., which, in addition to these, plays a role in the survival, health and well-being of the patient.
Value system: The patient may value warmth and compassion from the doctor — some doctors show no warmth or compassion. Some patients highly value good “bed-side manners”…
Power greater: Some patients believe that their well-being is determined by a force or power that supersedes the medicine they are being given. Some nurses, sharing such a belief, support their patients by telling them that “your attitude about your disease, and your recovery is very influential in the success of your recovery. If you believe that you are going to die, your chances of dying are greater. If you firmly believe that you are going to make it through this disorder, your chances of surviving are much better.”
Belief system: Some patients would like to pray or meditate with their nurse. Many nurses are insisting that this is healthy today. Many administrations of health care institutions are recognizing the value of this type of support from nurses for their patients (Reig, 2006).
Embedded in nursing school curricula, increasingly over the last 20 years, are required courses related to multiculturalism and diversity. These courses invariably involve study of different cultures and mores of the patient population, including belief systems, religions, mores, customs, and traditions — in other words, nursing students are being required to become versed in the spiritual practices of their patient population so that they can serve them better.
The Difference between Spirituality and Religion
Critics of the requirement of a spiritual practice in nursing may have varied motives, but the argument generally centers on the objection that this requirement violates the separation of church and state. Put simply, the critics confuse spirituality with religion. The vast majority of these criticisms have come from outside of the field of nursing (Swinton, 2006).
I was unable to locate an in depth oppositional statement, but rather mere references to the objection that people’s beliefs should be private and that no patient should be subjected to the religious beliefs of their nurse. In response to this I want to offer what I have found from what I believe to be very clear explanations regarding the difference between religion and spirituality. I will here refer to Lynn (2012) as a systematic explanation:
Religion and spirituality are distinct from each other. Here are three ways: (1) Religions are connected to private property, and in the instances of the most established world religions, this property is to the level of capital. Spiritual practices have no private property (no mosques, no synagogues, no churches); spiritual practices have no money. (2) Religions are hierarchical — just below the deity is the highest human representative of such. Spiritual practices know of no higher and lower humans. (3) Religions are ideological in that the “God” or “Allah” of such is the only truth. Spirituality is 100% non-dogmatic in that there is no claim to ultimate truth dictated to all believers and non-believers alike (Lynn).
The text, Spiritual Care: Nursing Theory, Research and Practice (Taylor, 2001) says that a belief system, “integrates all aspects of care for the patient. That is, because spirituality is an integrative factor that connects all aspects of a person’s life, nursing care is most effective when it acknowledges this integration.” (p24) This text further states that, “Many clients desire spiritual care from their health care professionals (e.g., open discussion of beliefs, prayer)” (p52).
Because spiritual beliefs are by definition non-dogmatic, health care professionals who are skilled at integrating spiritual principles in their practice are generally received very favorably by patients. There are numerous reasons for this:
One is that, despite the wonders of modern science, most people regard their life on the planet, in general, and their specific presenting ailment, as being governed by a power greater than humans. That their health care provider is also relying on a power greater than medicine, the doctor, money, and the limits of insurance benefits, is usually very comforting. Even in considering the wonders of modern medicine, many people understand such wonders as having an origin in a power greater than modern medicine.
Issues such as one’s perspective regarding hope, purpose, soul, universal connection, are all spiritual issues. When a health care professional, such as a nurse, addresses such basic issues as the health of a patient, these issues can and will come up. For a nurse to be well versed in sharing an approach which includes these values is a great advance in the health care profession in general, and for the nursing profession specifically.
The issue of the illness of the social system has come up often, particularly in my field research (interviewing friends and acquaintances). The vet who has returned from Iraq is exhibiting symptoms of PTSD. He then hears that one of the top Generals in the US military has admitted that the war was being fought to secure Iraq oil (for Exxon/Mobile, for Texaco, and for Chevron). His sense of lack of meaning, of hopelessness, of lack of purpose is all-consuming. He has killed and seen death and destruction, participated in such, and he does not know why. In this situation his nurse has been trained to support him in his search for meaning and purpose in his suffering, in his life.
Part of the definition of drug addiction is the loss of values. The disease concept of addiction, endorsed by both the AMA and the APA (Gorski, 2010), holds that it is a physical, mental and spiritual disorder. In order to recover, the addict must replace the addictive behavior with one which is guided by spiritual principles. All prospective nurses in nursing school today in the United States are required to become versed in the literature of Alcoholics Anonymous and Narcotics Anonymous, and to go to recovery meetings as part of their training.
The fact of millions of sufferers from seemingly unending and purposeless wars (we are just now learning that the US has been at war in Colombia for decades, the war in Iraq is starting up again, and Afghanistan never ended), from the disease of addiction — literally millions of people in this country alone have been diagnosed as being addicted — are both examples of what Capra calls “diseases of civilization” (1984). It is in response to such that the demand, first from the patient population, and then from all others connected to the profession of nursing, has come to provide care on the level of spirit.
Capra, Fritjof. (1984). The Turning Point: Science, Society, and the Rising Culture. Random House Publishing.
Center for Nurse Advocacy. (2007). “What is the nursing shortage and why does it exist?” http://www.nursingadvocacy.org/faq/nursing_shortage.html.
Gorski, Terrence, T. (2010) “Disease model of addiction.” The Addiction Web-site of Terrence T. Gorski. http://www.tgorski.com/gorski_articles/disease_model_of_addiction_010704.htm
Hutchison, Marg. (2015). “Healing the whole person: the spiritual dimension.” Christian Nursing Page. http://members.tripod.com/marg_hutchison/nurse-4.html
Lemmer, C.M. (2005). “Recognizing and caring for spiritual needs of clients.” Journal of Holistic Nursing, 23, 310–322.
Lynn, Alexander. (2012). “Spirituality and religion.” In The Community Teacher’s Guide to Liberation Pedagogy. Social Justice Education. www.sjeboston.webs.com.
Rieg, Linda, Carolyn H. Mason and Kelly Preston. (2006). “Spiritual care: Practical guidelines for rehabilitation nurses.” Rehabilitation Nursing. Vol. 31, №6. http://www.rehabnurse.org/pdf/RNC_264.pdf
Royal College of Nursing. (2011). “Spirituality in nursing care: A pocket guide.” https://www.rcn.org.uk/__data/assets/pdf_file/0008/372995/003887.pdf
Swinton, J. (2006). “Identity and resistance: why spiritual care needs ‘enemies’.”Journal of Clinical Nursing. Jul;15(7):918–28. Review.
Taylor, Elizabeth Johnson. (2001). Spiritual Care: Nursing Theory, Research and Practice. New York: Prentice Hall.
 Men comprise only about 6% of working U.S. nurses. (Center for Nurse Advocacy, 2007)