Spiritual Competence, Religion and the Deep South

[J.Adderton, BSN, MSN]

I have worked all my 24-year nursing career in the state of Alabama. According to the Pew Research Center, Alabama is currently ranked as #1 (tied with Mississippi) as the most religious state in the U.S. Religion is a strong thread in the cultural fabric in this state and a key consideration in providing culturally competent nursing care. I considered religion and spirituality as interchangeable throughout many of my nursing years. In 2016, I found myself in spiritual distress eventually- leading to a deeper understanding of spiritually competent nursing care.

In May 2016, I checked into an inpatient facility for treatment of alcoholism. I don’t think anyone enters detox without having to experience a significant degree of negative life consequences- such as loss of job, relationships and sense of self. Through my drinking, I did a great job of isolating myself from all the people, places and things I held most dear. After 10 weeks of inpatient rehabilitation, I realized I also lost my sense of spiritual connectedness. My treatment team would frequently to assess my spiritual condition by questions similar to these:

-Who or what provides you with strength, hope and peace on a daily basis?

-What is helping you through this experience?

-How do you express yourself spiritually?

-What personal spiritual goals do you hope to reach during treatment?

Important note: Our spiritual journey is unique to us- just as our patients’ spiritual journey is unique to them. The intent of this article is not to provide a “right or wrong” path to spirituality because it is different for every individual. To care for an individual in spiritual distress simply requires a nurse to support individuals in their own spiritual growth.

Prior to my spiritual crisis, I had inner laced religion and spirituality. I felt I was competent in supporting another’s spiritual needs but had little self-awareness of my own spirituality. I am certain living in a state where 53% of the population reports affiliation with a specific religion shaped my own perception of spirituality. In order to provide truly competent spiritual nursing care, I had to first understand the differences in religion and spirituality.

The Difference in Religion and Spirituality

Religion and spirituality are not the same, but the two often overlap. Spirituality reflects an interconnectedness with something bigger than ourselves and the search for life’s meaning. Christina Puchalski, MD, Director of the George Washington Institute for Spirituality and Health defines spirituality as “the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience connectedness to the moment, to self, to others, to nature and to the significant or sacred”. Both religion and spirituality refer to the belief systems and philosophies of people and are often used in similar contexts. Belief in a religion may be very spiritual to an individual. However, an individual may be spiritual without affiliation to an organized religious system.

Characteristics of religion include:

A formal, organized system of beliefs with practices, activities and rituals to facilitate closeness to the sacred or transcendent.

• Being a member of a group and following the teachings of others
• Interconnectedness linked to church, temple, mosque, synagogue, etc.
• Teaching and philosophies often based on the past
• Belief in a religion may be very spiritual to a person

Characteristics of Spirituality:

• A sense of relationship with believing in a power greater than ourselves
• Subjective and individualistic
• Spiritualism is a feature of the individual, not the group
• About finding one’s own path
• Inwardly directed
• Less formal and emotionally oriented
• Not authoritative
• May be spiritual without affiliation with a religion

The Experience of Spiritual Distress

I experienced spiritual distress when I was unable to find sources of meaning, peace, strength and connectedness. I felt as if I was in a deep and dark hole and lost all hope I could get out.

I am now more aware when other individuals are having signs and symptoms of spiritual distress. A person may ask questions about the meaning of life, their belief system or pain and suffering. They may also suffer from feelings of sadness, depression, anxiety, anger and depression. A sense of isolation, emptiness and feeling alone is common with spiritual disconnect.

Meeting Spiritual Needs

It is important to be aware of your own spirituality to support another experiencing spiritual distress. As nurses, we must meet patients “where they are” and not where we think they should be. By projecting our own beliefs and ideas about where the patient should be spiritually, we could potentially inflict more suffering. This can be challenging for healthcare providers in a highly religious state or area. Here are a few guidelines when providing spiritual care:

Don’t assume you know what is best for the patient and do explore what or who can help in reconnecting (meditation, prayer, journaling, art, nature etc.)

• Don’t give empty reassurances (“it will be alright”)
• Don’t debate religion or impose your own views
• Don’t try to “fix” your patient’s spiritual problems or answer “ unanswerable” questions
• Actively listen to the patient
• Ask “Who or what provides you with strength, hope and peace on a daily basis?
• Ask “How do you express yourself spiritually and what is helping you through this experience”.

Do you think nurses fall short of addressing patients spiritual needs? Does the culture in your area impact the spiritual care you provide?

Additional Information:

Spiritual Distress Patient Education

[OldDude]

Excellent article! You know what "they" say..."don't talk about politics or religion." As a side note - aethism could be considered a "religion." Once you're able to separate spirituality and religion you can see how much, virtually, everyone has something in common and spirituality can easily be discussed. Most people "believe" in something and, as nurses, if we can recognize and be an advocate for each patient's individual spirituality we'll greatly enhance that therapeutic relationship...which can contribute to "healing;" physically and emotionally.

Thank you "J." I really like your spirituality "ice breakers."

[neuron]

I am definitely guilty of giving what you say as 'false reassurance'. I have a habit of saying 'is everything ok?' or how is everything? when I walk in. well, no, someone is sick or about to pass I have had to work on that

[subee, MSN, CRNA]

Thank you for you elucidating the difference between religion and spiritual. I am a spiritual athiest and there are a LOT of us around. Leading an ethical life, IMHO opinion, is more difficult than doing the same in a religious life since no one believes in ALL religions at once, yet civilations ALWAYS require some ethical frameworks or they will wither.

[GrumpyRN, NP]

Sorry, double post.

[GrumpyRN, NP]

Thank you, I am fed up of people assuming that because I am atheist I am not spiritual.

On 3/1/2019 at 11:50 AM, OldDude said:

As a side note - aethism could be considered a "religion."

Not according to the IRS.

[OldDude]

On 3/2/2019 at 2:10 PM, GrumpyRN said:

Thank you, I am fed up of people assuming that because I am atheist I am not spiritual.

Not according to the IRS.

True that!! On both of your statements.

[Lane Therrell FNP, MSN, RN, NP]

On 3/1/2019 at 10:13 AM, J.Adderton said:

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Prior to my spiritual crisis, I had inner laced religion and spirituality. I felt I was competent in supporting another’s spiritual needs but had little self-awareness of my own spirituality.

This is a well-written article on an important topic. I grew up in North Carolina, so I can identify with your observation that spirituality and religion often get lumped together. Moving to California in my early 20’s allowed me to cultivate a different view, but it wasn’t until I survived domestic violence in my 30’s that I truly got in touch with my own spirituality.

To your point about providing spiritually competent care by meeting patients where they are, I definitely believe my own spiritual awareness has made me a better nurse.

[vetpharmtech]

The deep south is full of Southern Baptists, who really believe that non Christians would be burned for eternity if they don't believe in Jesus regardless of how decent they are.

Do you think that a Christian nurse in the deep south can respect a patient's spiritual autonomy without proselytizing to him/her?

Seeing the tension between atheists and Christians, I am cynical about the attitude toward non-Christian patients in the South. I am not even an atheist to have this feeling.

It is refreshing to see a nurse who has more nuances like you do.

[SafetyNurse1968, ADN, BSN, MSN, PhD]

In my first week of school for my doctoral program, we were talking about "other ways of knowing." I divulged that I am a confused agnostic...I truly have no idea what's going on, and mostly just spend my spiritual time fumbling around in the dark looking for the light switch. One of my fellow students asked, in a completely sincere voice, "If you don't believe in God, then how do you know right from wrong? How do you know if you are making good decisions?" I've never met someone so different from myself. She needed the Bible to guide her through her day. I tried to explain that I "just know" but it came out sounding lame. What's your response to that type of question? I'll save it for the next time someone is baffled by my lack of faith.

[Lane Therrell FNP, MSN, RN, NP]

1 hour ago, SafetyNurse1968 said:

In my first week of school for my doctoral program, we were talking about "other ways of knowing." I divulged that I am a confused agnostic...I truly have no idea what's going on, and mostly just spend my spiritual time fumbling around in the dark looking for the light switch. One of my fellow students asked, in a completely sincere voice, "If you don't believe in God, then how do you know right from wrong? How do you know if you are making good decisions?" I've never met someone so different from myself. She needed the Bible to guide her through her day. I tried to explain that I "just know" but it came out sounding lame. What's your response to that type of question? I'll save it for the next time someone is baffled by my lack of faith.

I am fascinated by discussions like this, and there are MANY different directions it could go. An appropriate response to a question about how agnostics make decisions might involve articulating the differences between ethics and morality. Ethics and morality are very different concepts, but drawing out the differences requires subtlety and nuance that sometimes gets suppressed inside religious (and even scientific!) dogma. And rarely gets taught in nursing classrooms.

The level of self-reflection in your post indicates to me that you don’t necessarily have a lack of faith, you simply have not yet found a way to define, describe, and articulate your own personal version of faith. Remember if you accept the premise that spirituality and religion are not synonymous, it follows that faith—or trust in something outside yourself-- doesn’t have to be religious.

I love it that your doctoral program began with an epistemological discussion (epistemology=the study of how we come to know). Nursing was a second career for me after earning a master of arts in rhetoric (rhetoric=how humans use words to make meaning), so I have a unique perspective on education in the biosciences. I’ve noticed that it’s all too easy for those of us with careers in applied sciences (aka nursing, medicine, and bioscience research) to forget that it’s ok to explore questions that have no answers. I believe these types of questions should be encouraged more in the biosciences because they arise from the intersection of science and art, and preserve the human relational elements of our practice.

[vetpharmtech]

14 hours ago, SafetyNurse1968 said:

In my first week of school for my doctoral program, we were talking about "other ways of knowing." I divulged that I am a confused agnostic...I truly have no idea what's going on, and mostly just spend my spiritual time fumbling around in the dark looking for the light switch. One of my fellow students asked, in a completely sincere voice, "If you don't believe in God, then how do you know right from wrong? How do you know if you are making good decisions?" I've never met someone so different from myself. She needed the Bible to guide her through her day. I tried to explain that I "just know" but it came out sounding lame. What's your response to that type of question? I'll save it for the next time someone is baffled by my lack of faith.

Your incident is the reason I don't like Christians, nor do I want to be taken care by Christian nurses. Somehow they think that people outside their worldview are controlled by the devil, morally corrupted, or lost without life meaning. In general, every possible condemnation that their bible taught them is what they project on non Christians.

I don't have sufficient knowledge in evolution psychology to explain how our views about ethics have changed over time for better. I simply say "it is my moral intuition. I simply know although I cannot explain why." If Christians cannot accept my agnostic view about ethics, that is their problem.

You don't owe any Christian justification for your ethical foundation. A person's ethics has many influences. Just because a Christian can assert their explanation with Yahweh does not mean their morals are better than yours or mine.

I hope you find a way to deal with that Christian mindset.