The spiritual dimension of nursing care

“Who can save a child from a burning house without taking the risk of being hurt by the flames? Who can listen to a story of loneliness and despair without taking the risk of experiencing similar pains in his own heart and even losing his precious peace of mind? In short: “Who can take away suffering without entering it?” 

This saying from one of my favorite books has never been as meaningful in my career as it is today. Nurses on the frontline risk being hurt by the flames of loneliness and despair every day as they walk into the proverbial “burning house” to save lives affected by COVID-19. And I continue to wonder how well we have equipped our fellow nurses with the protective spiritual gear that they need to avoid being burned by these flames. 

This past year has reminded us how important it is to nurture one’s own spiritual needs to effectively care for the spiritual needs of our patients. Spiritual care fosters physical healing, and the nurse who is equipped with adequate preparation in spiritual care can promote a healing environment that meets the holistic needs of patients while also nurturing one’s own spiritual needs. Spiritual, physical, and emotional health are all intertwined, and alterations in one dimension will impact all components of care. We need to prioritize providing nurses information on spiritual care if we want them to share that with themselves and their patients.

Barriers to spiritual care are multifaceted; however, one of the most common barriers I encounter is a lack of understanding of the definition of spirituality. Many people view spirituality as a construct of religion and immediately think of religious aspects when it comes to providing spiritual care. However, spiritual beliefs and values are not always linked to religion alone. While these aspects can and often do coexist, they can also be mutually exclusive elements of coping. Spirituality is a construct that is multidimensional, unique to each person, and broader than an individual’s religious beliefs or affiliations. Religious beliefs are related to a prescribed set of guidelines and an individual’s relationship with a higher being. Spirituality, on the other hand, is an inner strength that provides a sense of peace, meaning, purpose, and fulfilment. It is the way that one experiences their connectedness to the moment, to the self, to others, to nature, and to the significant or sacred. It reflects the universal quest that individuals seek to make sense of their existence or, even more so, the fragility of their existence. 

I recently read a research article which surveyed 11 chaplains to gain perspective on the role of nurses regarding spiritual aspects of end-of-life care. All the chaplains surveyed agreed that nurses need to have awareness of themselves and knowledge of their own spiritual background to connect with the needs and wants of patients with different spiritual needs. However, despite several studies showing that this aspect of patient care is vital to quality patient outcomes, nurses have continuously reported that their education has left them ill-prepared to deliver spiritual care in practice. 

I can relate to this as many of my students have indicated that their nursing curriculum does not place a sufficient emphasis on spirituality in education or clinical practice. In fact, many studies have also shown that students report that they do not even talk about spiritual care in nursing school, and they encounter very few nurses who discuss spiritual care with them in practice. This is perhaps because practicing nurses are also lacking the prerequisite knowledge and education to have these conversations with students, and this cycle has persisted.

To turn the tide and change the trends in nursing education and ultimately nursing practice, we must actively pursue a paradigm shift in the way that we approach and define holistic patient care. Teaching students to provide holistic nursing care requires educators to create opportunities to integrate concepts of spirituality early in the curriculum and share it throughout the program. I have a few simple suggestions to do this:

• Embed resources such as the End-of-Life Nursing Education Consortium (ELNEC) undergraduate curriculum 
• Implement holistic health assessments in the fundamentals course within extended care facilities which provides an opportunity to nurture hope and spirituality as students care for the aged
• Conduct spiritual self-assessments in first semester courses to identify any potential barriers to spiritual care
• Use clinical journaling to demonstrate a growing awareness of understanding spirituality and how to incorporate spiritual interventions in their clinical practice
• Utilize the “What? So What? Now What?” format to focus on analyzing clinical aspects of spiritual care in post-conference

Overall, without this knowledge, it is impossible for nurses to execute this type of care effectively. The education that nurses receive at the undergraduate level shapes their practice and how they view their role as nurses. While competence in pathophysiology, disease processes, and pharmacology are important, we cannot continue to ignore the value in developing professional competence in spiritual care. This skill requires students to regularly experience and reflect on real life situations and be aware of their own spiritual background. And we can only break the cycle by learning, as educators, how to best help our students to facilitate the development of sensitivity and the capability of nurturing the human spirit in clinical practice.

Chaka Brittain, DNP, RN, CNE, is an Assistant Professor of Nursing at the University of North Florida in Jacksonville, Florida, USA. She is a member of Sigma’s Lambda Rho at-Large Chapter.