This article discusses the importance of addressing patients' spiritual health but notes that nurses often avoid discussions of spirituality and religion due to confusion between the two concepts and concerns about offending patients. The author argues that spirituality is an essential part of human existence that is different for everyone, while religion refers to organized belief systems, and nurses should discuss spirituality without pushing religious beliefs. Two studies found that the majority of patients want spiritual discussions but around half did not receive them. The author advocates developing skills to discuss spirituality respectfully in order to help patients find strength.

1. 16 June 23, 2014 the kansas city nursingnews
By Mark Darby, RN
Special to Kansas City Nursing News
I
don’t want to offend them and I don’t want
them to think I am trying to convert them.
What would I say?
Since day one in nursing school, we are
told that we care for the whole person — body,
mind, emotions and spirit. Yet, when was the
last time you went to a patient asked about
their spirituality? How do you even do that?
I imagine something like, “On
a scale from 1 to 10, with 1 being
complete spiritual desolation and 10
being the strongest spiritual expe-
rience you can imagine, how would
you rate your spiritual health?”
Maybe even a spiritual CAT scan.
Well, until those days happen I
think we need to come to grips with
this issue. Studies show a correla-
tion between spirituality and health
(1) and up to 83 percent of patients want to
discuss spirituality (2) with their physicians.
Yet another study said half of the patients
who wanted a spiritual discussion were not
able to do so (3).
Summing up these studies, we could say
this about spirituality — it’s beneficial, a
good many patients want it but we don’t dis-
cuss it. This raises two questions: Why don’t
we and how can we?
Why don’t we?
I think the big reason is that we confuse
spirituality with religion. Spirituality is an
essential part of every human being. It is the
part of the human being that connects with
something greater than themselves. This
has many names – life purpose, connecting
with the divine, nature and God but it is dif-
ferent for everyone. Religion is an organized
rational system of beliefs about a supreme
being or beings.
For many, spirituality and religion are
synonymous, but we need to make this
distinction. As nurses, we recognize and
develop everyone’s spirituality. We respect
but do not change anyone’s religion.
Many religious organizations do great
work in health care. Millions of people
would not be alive today if the religious
organizations did not support and provide
health care. Even in these organizations, the
distinction between religion and spirituality
holds. We need to talk about spirituality. (In
the next article, we will speak more about
how to do this.)
When talking about religion, the culture
is divisive. The culture creates several ex-
pectations which prevent us from speaking.
We think that people are easily offended or
will recruit us to join the fold. The culture
draws a connection between arguments and
religion, and it is buffeted by some well-
known world conflicts that seem to pit two
religions against each other. This is the pri-
mary reason we don’t speak about
spirituality. We think we will offend
or more importantly be offended.
When we even think about speaking
about spirituality we are put on the
defensive.
This is really strange to me. When
it comes to a person’s health what
else are we afraid to talk about?
Nurses ask probing questions about
the color of bodily fluids or about
the pain in areas of the body that are not dis-
cussed in polite conversation. I can’t believe
we would rather talk about smelly pustules
with a cancer patient then ask them where
they get the strength to face such tragedy.
Yet we hesitate.
I like to think of discussing spirituality as
a skill that we need to develop as opposed to
a subject to be avoided. Yes, we could offend
but in this area the intention is key. When
we discuss spirituality we are trying to help
patients tap into hope and strength that can
make the difference between life and death.
As long as we have that intention, then the
questions is not why don’t we ask about spir-
ituality but how.
Which is the subject of the next article.
Sources: (1.) Johnstone, B. , Dong, P.,Cohen, D.
,Schopp, L. ,McCormack, G. ,Campbell, J., Smith, M.
(2012) Relationship Among Spirituality, Religious Practic-
es, Personality Factors and Health for Five Different Faith
Traditions. Journal of Religious Health. 51, 12017-1041.
(2.) McCord D, Gilchrist V., Grossman, S.,King, B., McCor-
mick, K., & Oprandl, A. et al. (2004) Discussing Spirituali-
ty with patents: A rational and ethical approach. Annals of
Family Medicine, 2(4), 356-361. (3.) Williams, J.,Meltzer,
D.,Arora, V.,m Chung, G., & Curlin, F. (2011). Attention to
Inpatients’ Religious and Spiritual Concerns: Predictors
and Association with Patient Satisfaction. Journal of
General Internal Medicine 26(11). 1265-71.
Mark Darby, RN, is the author of “Pharaoh’s Midwives:
A Retelling of the Nurse Midwives in Exodus” available at
www.mdarby.com/midwives.html
Overcoming obstacles when speaking
about spirituality issues with patients By Joshua M. Felts
Special to Kansas City Nursing News
A
s I slowly meandered down the prolifically straight
hallway, the mordant fumes of iodoform pierced my
nose. Swish! The automatic doors closed. The dark-
ness of the dimly lit, octagonal room enveloped me. I
wasn’t alone — the intensive care unit was a beehive of activity.
Unlike the rest of the staff, I was new to the ICU, and I didn’t
like it.
I’m a psych and rehab nurse — if I wanted to face life and
death every day, I would’ve chosen the ER. At least there, I’d
get a little crazy to balance out the acute myocardial infarc-
tions (MIs) and broken bones. Unlike most nurses, I prefer
conflict and verbal jujitsu, not ventilators and trauma. Never-
theless, my nursing preferences wouldn’t stop the destiny of
the trauma train from bulling me over.
Upon entering the octagon, I was directed to my left. The
scene wasn’t pretty — pure humanity laid
sprawled out before me in its wretchedness.
“What happened?” I asked.
“He was run over by a tractor!” someone
barked.
The patient was dead. I missed the code. In
all honesty, I was surprised he had even made
it to the ICU. His pelvis was crushed, his body
broken. Blood meandered from his abdomen,
coalescing with speckles of normal saline on
the floor.
“Well, we should get him cleaned up.”
I paused for a second, just trying to take in the scene. Like al-
ways, witnessing death was humbling. As I stared at his lifeless
body, my mind’s eye envisioned him hours earlier: full of life,
dreams for himself and his family still intact. Now, everything
he was and could have been was gone, the ripples of his legacy
now skipping across the universe.
As we performed post-mortem care, we tilted him to the left,
then the right, caring for him in death, much like we would
have in life. We gently wiped the blood leaching from the
corners of his mouth, ears and eyes. We did the best we could,
trying to make him look lively and somewhat reminiscent of
his formal self.
Once we were done, we solemnly notified the family that he
was ready, giving them one last informal opportunity to view his
body, presenting them with merciless mortality and the unfor-
giving reality in relation to the frailty of the human condition.
Now, back at the nurses’ station, I viewed the bewildered fam-
ily stand by his bedside, some of them crying, some of them not.
I briefly pondered life, death, and the nature of it all. I, like those
before me throughout the annals of human history, introspec-
tively inquired about the meaning of our existence. Momentar-
ily, I wondered about the nature of good and evil, asking myself
the age-old adage: Why do bad things happen to good people?
And then, as quickly as I asked the question of myself, I dis-
missed it. I’ll never know. I’m not supposed to know. The essence
of the question was beyond human, beyond my comprehension.
Now, I thought, it’s time to get back to work.
Joshua M. Felts, BS, BSN, RN, practices nursing in the Kansas City area. This story
originally appeared in www.mightynurse.com. Joshua can be reached at j.m.felts@gmail.com.
Alone, together in the ICU
Joshua M. Felts,
BS, BSN , RN
Mark Darby, RN
opinion