There was a striking juxtaposition of events recently when, at the same time concerns about the potential influence of Catholic ethos on the proposed new National Maternity Hospital in the grounds of St Vincent's University Hospital were being voiced, the School of Nursing and Midwifery at Trinity College Dublin (TCD) hosted an international conference on how nurses can respond to patients' spiritual health needs.
Curiously, the religious influence on healthcare decisions and services weren’t discussed at the virtual conference, which instead focused on the importance of educating nurses in holistic communication so that they can respond to patient’s spiritual health needs as well as their physical ones.
"We want spiritual care to be at the forefront and included in the education and training of nurses," said Prof Kathleen Neenan, chair of the spirituality research and interest group at TCD who organised the conference.
She argued that spiritual care that recognises and responds to the human spirit when faced with trauma, ill health or death is relevant in modern healthcare delivery. “It can include the need for meaning, a safe space to express oneself or a place to allow rituals for prayer or sacraments or a human presence.”
Embarrassed
Various speakers at the Spiritual Imperative in Healthcare conference acknowledged that nurses can sometimes associate spirituality with religion and consider addressing religious needs as outdated in a secular society. "Some nurses feel embarrassed if patients asked them to pass them a religious item or to hold their hand while they prayed," said Prof Fiona Timmins, head of school of nursing at University College Dublin.
Prof Timmins argued that there is a lack of recognition of the importance of patients’ spiritual needs. “Nurses are uncertain when to seek referral to a chaplain, uncertain about their own spiritual and religious beliefs and stretched for time yet they tell us that they meet patients who have spiritual needs so we have to engage with this and navigate this space.”
Rather than having a pre-determined view of what patients will need, nursing educators suggest nurses initiate informal conversations, encouraging patients to tell their story and to ask two simple questions – “what is important to you right now?” and “how can we help?”.
Prof Linda Ross, professor of nursing at the University of South Wales, spoke about how the Covid-19 pandemic brought spiritual care needs into sharp focus. "Educating nurses about spiritual care is more important than ever when patients are cut off from loved ones and often dying alone," she said.
“[During the pandemic] staff had to make decisions about which loved ones can visit and which can’t. They had to break bad news on the phone. They had to face their own losses and exhaustion and were sometimes unable to give the care they wished because of their own post-traumatic stress symptoms. All this disconnection triggers a crisis of meaning and existential distress.”
Prof Ross said that there can also be a lack of clarity on what spiritual care is. “Spirituality is a dynamic sense of meaning, purpose, transcendence and connection. It’s about what’s important to the person when they ask questions like why me? Why now? And what will happen to me?
According to Prof Ross, spiritual care is recognising and responding to those aspects of the person in a compassionate relationship. “Students tell us when spirituality is not conflated with religion, you can provide spiritual care to a broader range of patients with different world views.”
Some delegates also suggested that it was no longer appropriate to ask people about their religion in admission documents and instead to understand better the complex ways people connect with their spirituality.
Huge support
Prof Ross argued that there is no professional monopoly on spiritual care and spoke about her personal experience when her father was dying. “Chaplains are specialists but spiritual care is the remit of everyone in healthcare – nurses, cleaners, fellow patients. Patients can be a huge support to each other and very insightful. When my dad was dying, the cleaner was the best person for me.”
Elizabeth Johnston Taylor, professor at the school of nursing at Loma Linda University in California, spoke about the importance of listening holistically. "Holistic communication involves intellectual, emotional, physical and spiritual awareness. A holistic listener is a holy listener," said Prof Johnston Taylor, who is the author of What Do I Say?: Talking with Patients about Spirituality (Templeton Press).
Prof Johnston Taylor said that a lot of nurses don't encourage patients to talk about their spiritual concerns. "The ability to provide holistic communications seems low in nursing – at least in the United States. Patients often express their emotional distress indirectly so it's important to see life through their eyes. It's about acknowledging feelings rather than offering causative explanations. These conversations don't need to be longer than other conversations but if the nurses are trained, the conversations can be more therapeutic."
Prof Ross and her colleague, Wilfred McSherry, professor of nursing at Staffordshire University, spoke in detail about a new international educational programme for nurses on how to address patients' spiritual health needs. The so-called EPICC programme (Enhancing Nurses and Midwives' Competence in Providing Spiritual Care through Innovative Education and Compassionate Care) offers nurses training on how to engage with a person's spiritual, cultural and religious beliefs appropriately in the midst of busy clinical environments.
