Which question would the nurse ask to assess the spiritual strength of the patient?

Like many nurses, perhaps you’re uncomfortable with the notion of providing spiritual care. You might feel like the intensive-care nurse who said, “When a patient brings up a spiritual need, the only thing I know to do is call the chaplain. I worry that I’ll say the wrong thing.”
Every person has a spiritual nature. The spirit is part of and affects every aspect of the whole person, so its care should concern all nurses. Spiritual distress can be as agonizing as physical pain, and unfulfilled spiritual needs can hinder a patient’s progress. By providing interventions that relieve spiritual distress, you can help free the patient’s energy for physical, emotional, and social healing.
Don’t assume you have to be religious to give spiritual care. Although some patients have formal religious beliefs, many seek meaning in other ways. Spiritual interventions don’t have to be difficult or intimidating. By applying some key concepts, you can become more comfortable with effective spiritual interventions.

Respond to spiritual needs as they arise
A patient with a spiritual concern might not want to wait for an appointment with a chaplain, so be ready to recognize and respond to spiritual concerns as they arise. You can provide spiritual care at virtually any place or time—for instance, you can discuss spiritual matters while ambulating the patient.

Nine simple spiritual interventions
You can meet many spiritual needs through simple interventions. One nurse colleague, whom I’ll call Julia, found this out when she was hospitalized with a difficult pregnancy. Afterward, she told me, “My understanding of what we as nurses do to give spiritual care changed. The simplest things made an enormous difference to me.”
The nine simple interventions below will help you care for your patients’ spiritual needs.

1 Be there
Your mere presence is meaningful when you intentionally focus on the patient. You don’t even have to say anything; you can connect with the patient by being silent and trying to understand what he or she is experiencing. Concentrate on valuing, accepting, and empathizing. By giving your time in silent companionship and establishing an atmosphere of empathy and serenity, you can soothe deep spiritual pain.

2 Listen actively
Encourage the patient to talk by affirming what he or she says, asking open-ended questions, and offering reflective comments. When a patient expresses a spiritual concern, acknowledge this by saying, “That sounds troubling. Help me understand what you mean.” Maintain a matter-of-fact manner.
Reflect your understanding of the patient’s concerns by stating, “It sounds like you’re thinking a lot about what lies ahead.” On the day Julia realized she was facing 16 weeks of hospitalized bed rest, one nurse “took the time to listen to all my fears. She told me she didn’t have the answers to my questions, but she helped me remember my faith and think about how to leave my fears in God’s hands.”
Listening to patients doesn’t require much response on your part. Simply encouraging the patient to talk may be an effective spiritual intervention.

3 Use touch
Gentle touch is reassuring and comforting. When you touch your patient, you provide comfort, warmth, and connection. But first make sure the patient is open to physical touch. Ask, “Do you mind if I take your hand?”
Besides holding the patient’s hand, you might touch the arm or place your hand on the shoulder to show concern and caring. Even the touch you provide when performing a procedure can be a spiritual intervention if you intentionally focus on the patient and think about conveying comfort through your touch.

4 Reflect and remember
Help your patient think about previous experiences. Ask “What types of things have comforted you in past situations like this?” Help the patient remember the support he or she has received in the past from family, friends, or spiritual beliefs.5 Laugh
In a 2007 study of 100 hospice patients, every patient listed laughter as a spiritual need. During Julia’s hospitalization, she had “a fun-loving, cheerful nurse who came in and talked about things other than my condition. She engaged my family and me in planning a party in my room. She made the days go by fast.” This nurse met a spiritual need by creating happy experiences.

6 Share the experience
Join the patient in questioning the meaning and difficulties of life. Acknowledge that much about life’s purpose and why people suffer is beyond your understanding. As you explore such issues together, follow the patient’s lead. Learn to be comfortable with the patient’s tears and accept crying and other emotional expressions (including your own) calmly.

7 Pray or encourage the patient to pray
Prayer is one of the spiritual interventions patients request most often. It helps us connect with the spiritual dimension. If your patient asks you to pray, adapt your prayer to the patient’s beliefs and needs. Ask “What would you like me to pray for?” Use everyday language, and keep your prayer simple and short. Pray for the patient’s concerns. If you don’t believe in prayer or for some other reason don’t wish to pray with the patient, ask a coworker to do this.

8 Use inspirational words and music
Many people find comfort in reading sacred texts or inspirational materials. Offer to read from a book of the patient’s choice, or have a volunteer read to the patient. If desired, arrange for the patient to listen to music of his or her choosing; perhaps family members could bring in a CD player with a selection of comforting music.

9 Evaluate spiritual needs
Performing a simple spiritual-needs assessment can be an effective nursing intervention in itself. It gives the patient permission to express these needs and reveals what kind of language to use when providing spiritual care. If the patient tells you praying to Buddha provides comfort, you’ll know what name to use when talking about a higher spiritual power. (See Assessing your patient’s spiritual needs.)

What not to do
When providing spiritual care, be careful not to inflict additional suffering. Follow these guidelines:
• Don’t try to be something you’re not or to know something you don’t.
• Don’t give empty reassurances, such as “Everything will be all right.” You don’t know if everything will be all right.
• Don’t debate religion or try to impose your own religious or spiritual views on the patient.
• Don’t try to “fix” your patient’s spiritual problems or answer unanswerable questions. It’s fine to explore difficult questions with the patient. But if you offer pat answers, you’ll only belittle the patient’s concerns and may increase feelings of isolation.

Spiritual care promotes quality of life
Providing spiritual care benefits the whole patient and promotes all aspects of health and healing. In a 1999 study of more than 1,300 cancer patients, researchers found spiritual well-being affected quality of life as much as emotional and physical well-being.
My friend Julia experienced this—and gained a new perspective on nursing: “I came out of my hospitalization feeling stronger spiritually, and my view of nursing forever changed. Nursing isn’t just a job. It’s about strategically placed hands, faces, words, and care that reach out to people in their times of greatest need.”

Selected references
For a list of selected references, visit www.AmericanNurse Today.com.

Carole R. Eldridge, DNP, RN, CNAA, BC, is Associate Professor and Program Coordinator for the master’s program in nursing leadership at the University of Texas Medical Branch—School of Nursing in Galveston.

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