Contributor: Faith Tissot, RN, MSN-Ed, CCRN
Doctoral Student at Texas Women’s University
Spirituality, which can include religion and prayer, is a customary theme in nursing, healthcare research, and among healthcare professionals globally. Spirituality and religiousness are an adjunct for an individual to draw meaning from life events, a conduit for connectedness to an individual’s definition of the divine. They may serve as a source of comfort during adverse events (Brady et al., 2021). Recognizing the importance of including a patient’s spirituality and prayer needs has motivated the World Health Organization to develop a groundbreaking study and instrument to quantify prayer’s impact on a patient’s recovery and wellness (Whoqol, 1998). Prayer and spirituality constitute one of the six domains of quality of life in the World Health Organization’s Quality of Life Instrument (World Health Organization, 2012). Spiritual diversity is widespread due to “plural” religious societies worldwide. Thus far, Christianity, Judaism, Hinduism, Islam, Taoism, Sikhism, Jainism, Native, Confucian, Bahai, Shintō, and Buddhism are among the most widely known religions globally (Vaughn, n.d.).
Throughout the world, prayer is a profound expression of belief, surpassing cultural and religious boundaries. Whether spoken in solitude, sung in unison, or quietly pondered, prayer remains essential in human spirituality. Spanning different and diverse faiths, prayer is expressed in myriad forms, yet its primary purpose is to seek connectivity outside oneself, seek comfort, express thanksgiving, or gain direction; prayer in all its forms remains consistent. The more we understand religious and spiritual diversity and have access to practitioners as nurses and health care professionals, the better we can provide resources to attend to our patient’s needs.
Omitting spiritual and religious care presents an ethical dilemma, as well as offering spiritual/ religious care seeming coercive or beyond the scope of a religious practitioner’s training. Recalcitrance to provide spiritual/ religious care may harm long-term associations with healthcare organizations for individuals and their families. Suggesting and investigating practitioners for individuals requesting specific religious or spiritual services provides evidence of intentional actions of respect and maintaining the dignity of an individual (Brady et al., 2021).
Nurses, as well as other healthcare professionals, can benefit from increased mindfulness of an individual’s spiritual and religious needs, proper assessment of individual needs, knowledge of how to offer spiritual and religious care, and where to obtain services for individuals with religious and spiritual needs that are foreign to our own spiritual and religious understanding (Brady et al., 2021; Cohen et al., 2000).
When nurses and other healthcare professionals lead with the intention of peace in arenas where we hold power, we remain mindful that peace is the intent, method, and desired product. By holding intentions of assisting our patients in meeting their spiritual and religious needs with wholesome intentions, the effect can be increased trust, accord, and viable elucidation to complex religious or spiritual requests (Chinn, 2013).
Ray’s Theory of Bureaucratic Caring arose from a grounded theory rooted in discovering the accurate meaning of caring. The Theory of Bureaucratic Caring combines the humanistic elements of caring (religious, humanitarian, spiritual, and social) and its converse of caring (legal, efficient, and administrative). The connection between a human community and an organizational community brings life to the relationship between both concepts. Therein, we can introduce further concepts such as spiritual well-being and successfully integrate individuals’ spiritual needs into bureaucratic care (Ray & Turkel, 2019; Ray, 2021).
An underutilized resource is the presence of chaplain services within healthcare organizations. Interestingly, there are common misunderstandings regarding chaplains’ role within healthcare organizations. A common misconception is that chaplains are trained in one faith’s religious services and rituals. Commonly, chaplains are trained in multi-faith denominations and can provide an individual and their family with the hope and conciliation needed during illness. Chaplains and other trained spiritual service providers can discuss with and assist patients navigating rituals or experiences that provide comfort and support during care. Nurses and healthcare providers are ethically bound to maintain a non-judgmental position even if religious or spiritual counseling requests are averse to their beliefs (Brady et al., 2021).
Conversely, nurses and organizational caregivers are not duty-bound to participate in religious prayers or demonstrations of faith that oppose their religion or belief. Chaplains and other providers who speak to patients about preferential practices can assist patients in examining experiences and finding solace and comfort, acknowledging and supporting patients through varying types of prayer. Chaplains are trained to be erudite of all religious affiliations. Overarching themes noted with chaplain training is that due to their unique skill set, they are equipped to dispense appropriate aids to augment diversity in religious beliefs and have the tools to support a multitude of faiths and perspectives (Brady et al., 2021).
Suggestions can be made to expand studies to include a broader range of diagnoses and situations, such as the phenomenological experiences of individuals with chronic diseases, mental health challenges, and chronic pain conditions (Klitzman, 2022). Actions of sincere caring demonstrate acceptance, a willingness to expand our skill set, and return the nursing profession to its original roots of being a discipline, support, and recognition of our patients as individuals with religious and spiritual needs that may be foreign to us or different from our practices. Active listening and providing viable solutions, such as an interfaith-trained chaplain, gives individuals in our care choices they may not have deemed feasible to solve their quandary (Cohen et al., 2000).
On October 3, 2024, I was pleased to speak to Chaplain Lee Reed. Chaplain Reed is a member of the Chaplain department at Michael Debakey Veteran’s Affairs Hospital in Houston, Texas. Chaplains have individual specialties, which include end-of-life care, military duty, addiction specialists, and trauma, formation of therapy groups for concepts of forgiveness or family issues (many chaplains are licensed social workers or psychotherapists), and correcting misconceptions about chaplaincy. Their goal is to provide patients with spiritual care. They hold what is shared with them as sacred, and ethical considerations are held in high regard unless a threat to themselves or others is uncovered.
Chaplain Lee and I engaged in an in-depth, informative discussion regarding what skills were needed as a chaplain, the most often encountered spiritual needs for patients, and what he would wish nurses to know about chaplain services. Chaplain Lee illuminated the vast network of interfaith leaders throughout Houston that can be contacted via the chaplain office if a patient requests specific religious needs that the in-house chaplain cannot fulfill. Chaplaincy is a holistic and spiritually based service centered on human-to-human interaction when a patient requires spiritual care.
Chaplain Lee emphasized qualities essential for attending to another human being, such as adhering to patient confidentiality, courageously assisting patients to reflect realistically, and the skills required to be a fully present, attentive, engaged, and active listener. Chaplains are cognizant that they are providing an essential service within a bustling healthcare system, where nurses and other healthcare team members cannot devote the time needed to explore a patient’s spiritual cravings. He is hopeful that nurses will feel comfortable contacting their organization’s chaplain when a patient is in need of spiritual services that they may be unable to provide due to the nursing profession’s increased workload.
The most encountered spiritual needs for patients are forgiveness and regret. Forgiveness can be for themselves or for others before they leave this world, and regret can be for what has occurred or not occurred in a patient’s life. At times, patients need to verbalize what is lying beneath their demeanor. Reflection also occurs and can be healing for a patient, reflection on happy moments, or applying the fruits of reflection to heal oneself or another person in a patient’s life. Chaplains have the skills and tools needed to address family and personal issues and the resources to incorporate additional mental health services if required.
Acknowledgement: Thank you, Dr. Peggy Chinn, for your mentorship and assistance in improving this blog post.
References
Brady, V., Timmins, F., Caldeira, S., Naughton, M. T., McCarthy, A., & Pesut, B. (2021).
Supporting diversity in person-centered care: The role of healthcare chaplains. Nursing Ethics, 28(6), 935–950. https://doi.org/10.1177/0969733020981746
Chinn, P. (2013). Peace and Power: New directions for building community (8th ed.).Jones & Bartlett.
Cohen, C. B., Wheeler, S. E., Scott, D. A., Edwards, B. S., & Lusk, P. (2000). Prayer as therapy.
A challenge to both religious belief and professional ethics. The Anglican Working Group in Bioethics. The Hastings Center Report, 30(3), 40–47.
Klitzman R. (2022). Typologies and Meanings of Prayer Among Patients. Journal of Religion and Health, 61(2), 1300–1317. https://doi.org/10.1007/s10943-021-01220
Nursing Theory. (2023). Kolcaba’s Theory of Comfort. https://nursing-theory.org/theories-and- models/kolcaba-theory-of-comfort.php
Ray, M.A. (2021). Evolution of Ray’s Theory of Bureaucratic Caring. International Journal for Human Caring, 25, 159 – 175.
Ray, M.D., Turkel, M. (2018, September 18). Bureaucratic Caring/Transtheoretical Evolution of Ray’s Theory of Bureaucratic Caring. Nursology. https://nursology.net/nurse-theories/rays-theory-of-bureaucratic-caring-transtheoretical-evolution-of-rays-theory-of-bureacratic-caring/
The Whoqol Group. (1998). The World Health Organization’s quality of life assessment (WHOQOL): Development and general psychometric properties. Social Science & Medicine, 46, 1569-1585. https://doi.org/10.1016/S0277-9536(98)00009-4
Vaughn, R. (n.d.). Encyclopedia Britannica. What is the most widely practiced religion in the world? https://www.britannica.com/story/what-is-the-most-widely-practiced-religion-in-the-world
About Faith Tisson
Throughout my academic and clinical professional journey, I have prioritized continuous education and collaboration with experts in the medical and nursing fields. As an advocate for the continuance of academic and clinical scholarship via “Guardianship” of the discipline of nursing, I am a proud member of Sigma Theta Tau International Nursing Honor Society, Beta Beta Chapter Houston, Texas, an Intern for Nursology.net for 2024-2025, and a peer reviewer for American Holistic Nurses Association. Currently, I am pursuing a Doctor of Philosophy in Nursing Science at Texas Women’s University, Denton, Texas; my research interests, which ignite my passion, center on the lived experiences of young adults facing homelessness while aging out of the foster care system. My advocacy for foster children has led me to serve as the chair of Communications and a Carrying Hope Houston board member. In my leisure time, I find joy in quiet time in prayer, the company of my family, my children with paws, church family, and engaging in reading and gardening hobbies. My ORCH-iD is 0009-0005-2595-5895.