Nurses talking religion with patients - fine line - page 4

Nurses who talk about God and spirituality with their patients can walk a fine line between comforting the ill and stepping on theological toes. That's the lesson Cape Cod Hospital per diem nurse... Read More

  1. by   LaneyB
    Thanks tn - it is within our scope of practice to assess this.

    I don't think most people are arguing whether it is in our scope of practice to assess this - I think we are arguing what constitutes an assessment. Imposing your own brand of religion on the patient is not assessing their spiritual needs. It is meeting your own needs, and that is not what you are there to do.
  2. by   Spidey's mom
    Quote from LaneyB
    Thanks tn - it is within our scope of practice to assess this.

    I don't think most people are arguing whether it is in our scope of practice to assess this - I think we are arguing what constitutes an assessment. Imposing your own brand of religion on the patient is not assessing their spiritual needs. It is meeting your own needs, and that is not what you are there to do.
    I don't even remember anyone saying we should impose our own brand of religion on anyone. I think we've all said don't proselytize.

    In essence, we are all pretty much in agreement.

    steph
  3. by   VivaLasViejas
    I think there is a very big difference between "imposing religion" on a patient and reaching out spiritually to a receptive person.

    Why, I ask, should it be inappropriate to discuss faith if the patient has initiated the conversation? Why should we not offer a prayer for a patient who has requested one? No one is "imposing" anything here, no one is saying "If you don't believe what I do, you're going to Hell".

    I myself have never initiated such conversations with patients, but having trained as a parish nurse and being at ease with many different faith traditions, I'm generally comfortable with continuing them. It helps, I think, to have a "feel" for a patient's spiritual needs, because sometimes they say "I'm OK with dying (or being ill)", but deep down are conflicted and frightened. And sometimes they are very much at peace with what is. Either way, you don't want to be seen as prying this information out of them---this is where a lot of well-intentioned nurses go wrong---and you certainly don't want to create spiritual distress where there was none!

    But I still see absolutely nothing wrong with praying with/for/over them if that's what they wish, or sharing your faith with them. Yes, you have to be careful of how you present yourself, but the wise nurse keeps the focus always on the patient and his/her individual needs. We have to remember that it isn't about us, it's about what THIS patient needs at THIS moment in time.

    JMHO.
  4. by   Neveranurseagain
    To quote Spidey'smom:
    "Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that a spiritual assessment be completed on every patient."

    Yes! We should do a spiritual assessment on all our pt's. But that does not include offering religious views or opinions.

    So if it is ok to pray with a pt.then I should remind them of the Four Noble Truths and the Eightfold Paths. And if a pt reaches out to me and I tell them I am an atheist--that may may them uncomfortable to have me as a nurse.

    Religion is a extremely personal preference, and should not be offered as being part of a nurse's job. A spiritual assessment needs to be done, but occasionally pt's end up offended when the nurse tries to offer her version of religion, as evident with this thread.

    Life is suffering....
    Last edit by Neveranurseagain on Apr 19, '09
  5. by   dnp2004
    I am wondering if this is more of a regional issue. In this part of the country, these issues/complaints don't seem to come up as much. Patients and staff seem to know where the "invisible line" is.

    At any given time we have patients and staff practicing over 25 faiths (seriously) but I have yet to receive complaints or witnessed what maybe considered inappropriate behavior. We keep an updated list of various religion churches/organizations/clergy in the area. The patients really appreciate being able to fellowship with those of their own faith.
  6. by   pagandeva2000
    It would also be beneficial if Staff Education wrote a summary of some of the most common religions and distributed them throughout their nursing staff, along with instructions on how to assess the spiritual needs of the patient. Sometimes, this has to be re-iterated to people.
  7. by   Spidey's mom
    Quote from Teresag_CNS
    I ask patients if they have spiritual beliefs that give them comfort, and build on those if so. There are many ways to incorporate the spiritual into nursing care without proselytizing. One does have to draw the line at offering advice to repent or praying without being asked to.

    Frankly, I think the distinction between what is appropriate and what is not is pretty clear: if the person does not agree to the discussion or the support you are offering, then it is wrong.


    Quote from dnp2004
    I am wondering if this is more of a regional issue. In this part of the country, these issues/complaints don't seem to come up as much. Patients and staff seem to know where the "invisible line" is.

    At any given time we have patients and staff practicing over 25 faiths (seriously) but I have yet to receive complaints or witnessed what maybe considered inappropriate behavior. We keep an updated list of various religion churches/organizations/clergy in the area. The patients really appreciate being able to fellowship with those of their own faith.

    Maybe you are right about the regional idea.

    And educating nurses about different faith beliefs is a good idea. During my parish nurse (Faith Community Nursing) training, we had a panel of individuals from our community representing many different faiths - it was the most informative and enjoyable part of the training. And all the panelists work together on a community committee - with NO fights! Amazing.

    steph
  8. by   vashtee
    Quote from KateRN1
    I find it interesting that the majority of the posts assume that the nurse is either of the same general faith (Chrisitan of some variety) or an atheist. I remember being in nursing school in the Bible Belt, USA and being very uncomfortable with patients, students, teachers, etc., asking me to pray. What if I had started it off by covering my head, saying "Allahu Akbar" and proceeded to rakat as was appropriate for the time? (If the aforegoing didn't clue you in, I'm a Muslim.) I am still incredibly uncomfortable with the spiritual culture of our American hospitals where it is assumed that patients are Chrisitians, an occasional nod to Judaism, but not a whisper for other faiths. I've never seen a "Happy Ramadan" or "Eid Mubarak" poster anywhere, but I sure do get to hear about Christmas, Easter, Passover, and other holidays. I was also told in nursing school that if we delivered a baby and the parents wanted him/her baptised and there was no clergy, that it was our responsibility to do so. Now that is whack.

    I *will not* pray with a patient. Unless the nurse is a parish nurse, it is outside of the nurse's scope of practice, IMHO.
    Where I live, it is assumed you are Christian (of some sort) - not even atheist. I've decided to quit correcting people when they assume I am Christian because they look at me like I killed their cat if I tell them I am Jewish.

    Anyway, with regards to a patient's spiritual care - My assessment consists of me asking if they'd like to see clergy (we are told that we can get someone of pretty much any faith). My intervention consists of contacting the clergy person and ensuring they came. I suppose if someone knew I was Jewish and wanted me to pray with them, I would. Otherwise, I consider it out of my scope of practice. The hospital hires clergy for a reason, and I am busy enough as it is without trying to wear yet another hat.
  9. by   ®Nurse
    http://www.efn.org/~nurses/nanda.html#ego%20integrity

    spiritual distress (distress of the human spirit)
    spiritual well being, enhanced, potential for


    these are actual nanda approved nursing diagnoses under "ego integrity".

    i find it very interesting that a discussion is brought up about religion. it truly is a very 'spirited' debate.
  10. by   pagandeva2000
    Quote from Spidey's mom
    Maybe you are right about the regional idea.

    And educating nurses about different faith beliefs is a good idea. During my parish nurse (Faith Community Nursing) training, we had a panel of individuals from our community representing many different faiths - it was the most informative and enjoyable part of the training. And all the panelists work together on a community committee - with NO fights! Amazing.

    steph
    I am a proponent of educating each other on different faiths. At least if there is an investigation of what faiths are within a certain geographical area and then incorporating into documents to distribute might better serve the patient population. In addition, if some of the spiritual leaders are willing to render their services, maybe they can be called to address the patient's needs in their final hours.
  11. by   NickB
    Quote from awsmom8
    Assessing the need for spiritual care is taught by schools(and this is where you call the chaplain), but I was not aware nursing school teach nurses how to meet pt's spiritual needs by offering their take on religion.

    Did you go to a religious nursing school?
    Wow, you're really trying to find negative in my post. I never once said anything about offering my take on religion. I said that it is important to support their spiritual needs. If they would like you to pray with them and you feel comfortable doing it, I think it is important to do so. They don't teach you to "Up and Call the Chaplain" at the first sign of spiritual need. As a matter of fact, they were very specific on the fact that you should try to fill that spiritual need for them, unless you absolutely feel uncomfortable doing so. It was a state school, not religious.
    Last edit by NickB on Apr 19, '09
  12. by   NickB
    Quote from LaneyB
    I am very curious to read how Nick B responds to the many posts on here. Nick, if you do respond, do you agree that while it is appropriate to assess spiritual needs, it is not appropriate to bring up your own personal beliefs unless directly asked?
    That pretty much sums it up. I am a Christian and with that believe in what the Bible teaches. If a patient who is also Christian would like to discuss spirituality and Christianity, then I have absolutely no problem doing that. If someone who is Hindu asks me to pray with them, then I would offer that I am a Christian and may not pray the same way that they do. I would tell them that I would be more than happy to be with them while they pray their way, or I would be willing to find someone who may be Hindu to pray with them. I wouldn't try to tell them that their religion is wrong and mine is right, as I feel everyone is entitled to their own beliefs. But I don't think the answer is to just go find someone at the mention of religion. I think a lot of people in this world are scared of religion or have had a bad experience with it in the past, and therefore reject it. What upsets me is the fact that if someone rejects it, than they don't want it anywhere around them and I feel that we all have the right to choose to practice religion or not. If this woman was beating her bible in front of a patient who did not want to discuss religion, than she was absolutely wrong. That would be no different than forcing a patient to take a medicine that they have the right to refuse. But, if this patient asked this woman to discuss this with her as the patient was concerned about the imminent onslaught of death, and it was only some atheist family member who is ****** off about it, than we have a completely different situation.

    LaneyB, thank you for your directness and asking me to clarify and for not just making assumptions about me. I really appreciate that.
    Last edit by NickB on Apr 19, '09
  13. by   carolinapooh
    Quote from Teresag_CNS
    No. Because it is part of holistic care. Because no one else on the health care team will do it. Because it helps the person cope with illness and loss. Because attention to the individual's spirituality is part of caring. Because it's usually the nurse who identifies the need to call the chaplain or clergy. Because patients' families appreciate it.
    Because taking vitals, passing medicines and doing various treatments are only a fraction of nursing care. Because nurses know patients as individuals, not merely "cases." Because we know that isolation and fear are the enemy. Because it comforts.
    Exactly.

    One of my most cherished memories from nursing school is that of a preacher (I still remember his name) who had had a TURP. He was TERRIFIED - really scared to death. I took care of him for two days and had picked up on all sorts of unspoken stuff (namely how scared he was). I met with him and the ostomy nurse (the prostate cancer had spread and he now needed a urostomy and was learning self-care). He was making progress in this area and I was really proud of him - he was at the point he was taking control of his daily care and I sensed what a big move this was for him.

    The last day I was there, he took my hand and asked me if I would pray for him, if I had a couple of minutes to sit with him and pray.

    So I did.

    I consider myself an agnostic - but I'm religious enough that when I got married I thought it needed to be in a church. I'm a baptized United Methodist raised by a Catholic and a Baptist (oh yes, the combination. . .). I place equal importance on Methodist Hall in London and the Pope in Rome. I don't talk religion with people that I don't know but I find the topic interesting. I've lived in Europe, the US, and Saudi Arabia and have seen firsthand all kinds of religion, the good and the bad.

    But it was very important to this patient that I do this - I'll never forget the tears in his eyes or how he held my hand and thanked me. And when I talked about it in post-conference, my instructor told me he'll always remember that I did that.

    I now work on a cancer floor. And when a patient asks me if I believe in God, I tell them I do. How far the conversation goes from there depends on how well I know the patient (and some patients I've cared for eight, nine times - seriously) and how far the patient wants the conversation to go. If I feel I'm in over my head, I usually say I don't think I'm qualified for it (with a smile), and I'll call the chaplain for them.

    I cared for a pt last night who is actively dying. At this point he's essentially unresponsive except to pain. All sorts of people had been to see him and he had a photo of two little girls - his nieces - on his chest. His bosses had even come in and made sure his wife had the appropriate paperwork taken care of so she could collect some type of payment from his union when he dies. I put the picture in the pocket of his gown and told him he must be a wonderful man to have all of these people see him and want to take care of his family. But religion? Nope - wouldn't touch it.

    Force my views on someone? Heck no.

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