Sunday, December 9, 2007

Prayer in Nursing

With spiritual care being a part of holistic care, nurses need to utilize prayer more effectively for spiritual well being, through implementation of guidelines to help nurses utilize this very important role in nursing care. There are many components of holistic care, and all of them should be recognized and implemented in care for the patient.
Nurses seem to be lacking the comfort and usage needed in spiritual care to give total holistic nursing care. Assessment of the patient’s desire for prayer or spiritual care can help solve this problem. Many nurses may not have the time or familiarity with prayer and other forms of spiritual care, therefore implementing guidelines for prayer and spiritual care are necessary to insure that all patients receive the best experience they can get. If the nurse does not have the time or knowledge, then pastoral services are available and a good resource for the patient’s spiritual needs.
Although prayer is a long established nursing intervention, praying with patients is still very controversial. It has been asked if praying with patients is ethical. The answer is that it is, if the nurse is true to the patient and themselves. Evaluation of the nurse’s own spiritual beliefs and comfort in spiritual care is essential to being sincere in providing this form of care. Taylor (2003) suggests that nurses should also seek to understand the relationship between prayer in care giving and patient/family coping. Maintaining integrity in spiritual care is important and essential in maintaining ethical standards. The question according to Wallace (n.d.) is, “Should we pray with their patients”? According to Taylor (2003) a considerable number of studies have identified prayer as a frequent and favored coping strategy among patients. Which answers the question of if nurses should pray, but a personal assessment is still necessary in each individual case. Prayer works. In recent research studies it is indicated that prayer reduces complications in CCU patients (Wallace n.d. para 2&3). According to Maier-Lorentz (2004) “The prayer group (n = 192) patients consisted of Christian born-again individuals who willingly offered prayers from a distance for these individuals whom they had never met, although they were given their names. A second group (n = 201) from the same CCU acted as the control group, and these individuals were not assigned to others to pray for them. Results indicated that patients who were prayed for had significantly less congestive heart failure, used fewer diuretics, had fewer cardiopulmonary arrests and less pneumonia, used fewer antibiotics, and were less intubated than those who did not receive intercessory praying from the born-again Christians” (para. 19). With this in mind prayer as an intervention with patients, fits the broader spectrum of spiritual care (Winslow & Winslow, 2003, para. 4).
One nursing strategy is to assess a patient’s desire for prayer or spiritual care. Assessing the patient’s need is essential for providing true holistic care. Every patient whether they are religious, spiritual, or, agnostic has needs for spiritual or emotional support. “Nurses must conduct a spiritual assessment to be involved in a caring-healing relationship that transcends all other dimensions of the physical world” (DiJoseph & Cavendish, 2005, para. 27). By allowing the patient the opportunity to reveal their beliefs or values, nurses can “understand the patient, meet spiritual needs, and provide appropriate support” (DiJoseph & Cavendish, 2005, para. 27). Using assessment skills to determine the patient’s need for spiritual care is a way to get to know the patient’s understanding and value of prayer. The nurse may try this statement to assess the patient’s desire for prayer as a coping mechanism, ‘It has been shown that prayer is a common way for people to cope with illness and life in general. Does this apply to you?’ Some other questions that may help in the assessment are, “Do you consider yourself spiritual or religious? [...] How might health care providers address any needs in this area?” (Winslow & Winslow, 2003, para. 14). If the patient answers affirmatively about prayer and the desire to receive support from the nurse, these following questions may also be helpful. “How important is prayer to you now?” or “How helpful is prayer for you now?”(Taylor, 2003, Table 1). Spiritual care may be as easy as the "gift of presence" through listening to you patient.
Another nursing strategy to help meet the spiritual needs of a patient is to implement guidelines for prayer in patient care. Suggested are some questions/ guidelines that may be appropriate. When should nurses pray with their patients? “The need for prayer during illness, even for people who do not consider themselves to be particularly religious” (Wallace, S., n.d. para. 5) is much higher and more common than many nurses probably know. Prayer with your patient is a personal choice and should not be taken lightly, but if the patient wants prayer, the nurse needs to address that need. Determining if prayer is an appropriate intervention is the first step to figuring out when to pray with a patient. If the patient suggests that, it is appropriate, asking them if they would like you to pray or for to just be present in silence with them, may be the best course of action. According to Taylor, how will a nurse know whether to pray or even discuss spiritual care with a client is a question that many nurses have asked (2003). First, permission from the patient is crucial before any prayers by the nurse should be said or thought. If the patient grants permission, the best thing to do is follow the patient’s cues as to how to proceed. When the patient specifically asks the nurse to pray for them, the next step would be to find out how they pray and what their beliefs are. An adequate assessment of a patient’s spiritual strength, needs, resources, and preferences will often include some knowledge of his or her religious tradition (Winslow & Winslow, 2003, para. 16). The nurse should focus on the patient’s spiritual needs and not their own. If the nurse does not have the same beliefs, then they should inform the patient that they are available to listen and be present while the patient prays but does not feel qualified to properly pray for them. When this happens, utilizing the hospital’s pastoral resources is an option.
Pastoral services are a good nursing strategy when the nurse is unable to provide for the patient’s religious needs. Whether it is when a nurse does not feel comfortable, they are lacking the knowledge base required for praying with the patient, or if the nurse just does not have the time necessary to address the patient’s spiritual needs, pastoral care is available. Pastoral support services may not be the exact religion or belief system that the patient follows, but they are trained in providing spiritual care. They can provide a more personal and in depth manner of care than the nurse may be able to. If the particular religions supported by the hospital are not sufficient, then they have resources outside of the hospital that can be used. Pastoral care should be able to address the patient’s needs when the nursing staff cannot, whether personally or through other religious avenues.
Praying is one of many ways to be effective in spiritual nursing care. Establishing guidelines for spiritual care and/or prayer is necessary if nurses are going to be able to provide this very important component of holistic nursing care. Assessing the patient’s need for prayer is another key element in providing good care. In the event that a nurse is not knowledgeable, uncomfortable or to busy to provide personal spiritual care and prayer, than hospital pastoral services are available. A nurse should never neglect or ignore a patient’s spiritual needs.

a. Intervention 1 (Assessment of patient’s desire for prayer or spiritual care)
i. Disadvantage 1 (Too many assessments too little time)
Assessments are the registered nurses job and priority. These assessments include respiratory, cardiovascular, skin, gastrointestinal, neurological, and psych/psycho-social to name a few. With all these assessments necessary to maintain proper care of the patient and keep them alive it would seem that assessing spiritual needs might not be prudent to the nurse, although it is definitely taught that spiritual well-being is part of holistic care. Nursing is a very fast paced stressful field of work, and nurses often have more than four patients to care for at any given time and the ongoing needs of the patients should come first. Some patient care events such as assessment, giving medications, and blood sugar checks are time specific and cannot be put off or ignored, while other patient care events can be juggled around to fit the time constraints of the nurse. Prioritization of these events enables the nurse to accomplish the job within the shift, yet emergencies can and do happen. (Navuluri, 2001) With all these patient care events, it is no wonder that spiritual care often takes the back burner in priorities.
ii. Disadvantage 2 (Delivery may discourage patient from verbalizing desire)
According to a national survey in 2004 of over 200 Americans, over one-third prays for good health. Among those who said they pray for specific health problems 69% stated that the prayer was helpful. Researchers say that people who are ill may turn to prayer as a means of coping, but on average 1 in 10 actually verbalize the desire to their nurse.(McCaffrey, et al. 2004) This may be due to the approach or delivery that the nurse uses to assess the patients desire. The delivery or route taken in order to acquire an assessment for the desire of prayer can vary greatly. If the nurse is friendly forthcoming and honestly believes in the assessment then the likelihood is that the patient will cooperate and verbalize the desire to pray if it is there. If on the other hand the nurse is short and seems distracted during the assessment results will more often than not be that the patient will keep their desires to themselves.
b. Intervention 2 (Implementing guidelines for prayer and spiritual care)
i. Disadvantage 1 (Noncompliance)
Implementing guidelines in nursing for prayer is a good idea, but there is a potential problem. While there are many guidelines in nursing, there has never been a specific set of universal guidelines for prayer. This may be due to lack of resources or interest in the subject. Without nurses, pursuing the development of these guidelines there is a huge potential for facilities to not put forth the effort to implement guidelines. With this in mind, it is not too far fetched to think that if guidelines were established but the nurses were not aggressive about implementing them then noncompliance would follow. Guidelines have been established for many different aspects of nursing and some of these are not followed as well as expected. If these guidelines are not being followed then who can expect that prayer guidelines would be, especially since prayer in nursing is not being used to its full potential as it is. Nurses may feel that they have not really used prayer so far in their care of patients so why should they start now even with guidelines.
ii. Disadvantage 2(establishing guidelines that apply to all patients)
Once the idea of guidelines has been established, we then face the problem of creating guidelines that will fit all aspects of prayer and spiritual care. This would be a very time consuming process, especially considering the many different beliefs in this world today. If the guidelines seem to cater more towards one belief than another does, it could cause serious problems with the religions or cultures of those that are not the majority. While this is understandable, it would also be almost impossible to incorporate all cultures, religions, and beliefs into one set of guidelines. This in itself can be a barrier in the implementation of prayer guidelines and then when you add in the reactions from the patients if guidelines were actually implemented but the patient’s beliefs did not fit the mold. Which would cause further issues with establishing guidelines for nurses and prayer?
DiJoseph, Josephine, & Cavendish, Roberta. (July-August 2005) Expanding the dialogue on prayer relevant to holistic care. (CONTINUING EDUCATION). In Holistic Nursing Practice, 19, p147(9).Retrieved April 16, 2007, from Expanded Academic ASAP via Thomson Gale
Maier-Lorentz, Madeline M. (July-Sept 2004) The importance of prayer for mind/body healing. In Nursing Forum, 39, p23 (10). Retrieved April 19, 2007, from Expanded Academic ASAP via Thomson Gale
Navuluri, R.B. (2001). Our time management in patient care. Retrieved October 20, 2007, from
Taylor, E.J. (2003). Prayer’s clinical issues and implications. Holistic Nursing Practice, 17 (4), 179-188. Retrieved September 28, 2005, Expanded Academic ASAP database
Wallace, S. (n.d.). Should you pray with your patients?. Retrieved October 29, 2005, from
Winslow, G.R. & Winslow, B.W. (2003). Examining the ethics of praying with patients. Holistic Nursing Practice, 17 (4), 170-178. Retrieved September 28, 2005, from Expanded Academic ASAP database

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