In the deep south, spirituality and religion are terms frequently used interchangeably. There are overlapping characteristics in both religion and spirituality, but they are defined differently. In order to provide spiritually competent care, it is important to understand your own views, as well as, the impact of community culture.
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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?
