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Online Survey of Nurses' Personal and Professional Praying

O'Connell-Persaud, Shannon, BSN, RN; Dehom, Salem, MPH; Mamier, Iris, PhD, RN; Gober-Park, Carla, PhD, MPH, MS, RN; Taylor, Elizabeth Johnston, PhD, RN

doi: 10.1097/HNP.0000000000000323
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This study explored how nurses' prayer beliefs and practices are associated with their offering to pray with patients. Participants (N = 423) completed an online survey. Those with higher prayer experience scores were 9% more likely to offer prayer to patients; those working in religious settings were 2.5 times more likely offer prayer to patients.

College of Nursing, South Dakota State University, Brookings (Ms O'Connell-Persaud); School of Nursing (Mr Dehom and Drs Mamier and Taylor) and School of Religion and Center for Spiritual Life & Wholeness (Dr Gober-Park), Loma Linda University, California.

Correspondence: Elizabeth Johnston Taylor, PhD, RN, 1555 Linda Vista Ave, Pasadena, CA 91103 (ejtaylor@llu.edu).

The authors are grateful to many people who made this work possible, including all the nurses who completed the surveys, and the Editors-in-Chief, who provided access to these nurses via their journal home pages (ie, Kathy Schoonover-Shoffner, PhD, RN, Journal of Christian Nursing; Shawn Kennedy, MA, RN, FAAN, American Journal of Nursing; and Maureen Anthony, PhD, RN, Home Healthcare Now). The authors also thank Chintan K. Somaiya, MS, MBA, for his technical assistance with data collection.

This work was supported by the School of Religion and Center for Spiritual Life & Wholeness, Loma Linda University.

All authors declare no conflict of interest.

Praying for health is common among persons of all ages.1 Individuals faced with illness report prayer increases in frequency and importance; indeed, it is one of the most often used “complementary therapies.”2,3 Given that health challenges often prompt people to pray, nurses historically and currently sometimes pray with patients.4 This article, therefore, examines how nurses' personal beliefs and practices regarding prayer might be associated with how often they pray with patients. This will allow nurses to gain understanding about how personal beliefs and professional practice may intersect during the provision of spiritual care.

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BACKGROUND

Empirical studies about prayer in the context of living with a health-related challenge are numerous. In previous decades, the focus of this body of research was often on intercessory prayer for positive health outcomes; meta-analyses concluded that such prayer was “equivocal and, although some of the results of individual studies suggest a positive effect of intercessory prayer, the majority do not.”5(p2) Thus, during the past decade or so, researchers have primarily studied the associations between prayer experience and psychological outcomes. This collective evidence suggests that prayer is generally positively associated with or contributes to various positive psychological outcomes.6–8

But how do sick patients perceive and practice prayer? If it is helpful, then do they want nurses to pray with them? How do nurses perceive prayer and think about it as a part of nursing care? The literature reviewed is delimited to that which informs these questions about prayer in the context of nursing.

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Patients' use of prayer

Several studies, including surveys with large samples asking the general population or patient populations about their use of “complementary therapies,” have documented the prevalence of prayer for health concerns. Surveys have documented that 35% to 47% of Americans prayed for their health.2,3,8–12 For instance, Wachholtz and Sambamthoori13 analyzed National Health Information Survey—Alternative Medicine Supplement data from more than 22 000 people and learned that 49% had prayed for their health during the previous year. Such surveys sometimes follow up with a question inquiring as to whether prayer is perceived as beneficial. For example, in the O'Connor and colleagues11 stratified sample of participants enrolled in a managed care organization in Minnesota (N = 4404), 90% of those who had prayed believed that prayer had improved their health. In contrast, findings from a study of Australian older adult women's health behaviors revealed that 74% of nearly 10 000 women reported that they rarely or never used prayer or spiritual healing.14 While this difference between American and Australian samples may be explained by culture, these studies did indicate that those with illness are more likely to pray. Indeed, this corpus of evidence suggests various factors that appear to be associated with whether one prayed for health. These factors include presence of illness, decreased physical function, or a recent health change; being female, African American or Hispanic (vs white), or married.

This evidence indicates that a substantial number of patients pray about their health and find it beneficial. But for what do patients pray? Jors et al15 completed a systematic review of 16 studies pertaining to prayer in the context of illness. Their review revealed that most evidence is based on the experiences of chronically ill persons (especially those with cancer). Jors et al categorized patients' prayers as disease-centered prayer, assurance-centered prayer, God-centered prayer, other-centered prayer, and lamentation. Although disease-centered prayer was the most common form of prayer, these researchers concluded that prayer allows individuals to positively transform the experience of illness.

While these studies describe patients' use of prayer quantitatively, a few studies also describe this qualitatively.16,17 Although these studies document the comfort and guidance prayer brings to those with illness, the study by Taylor and colleagues18 went further to describe the potential concurrent spiritual conflict that can occur with use of prayer. These researchers interviewed 30 patients with cancer and identified during secondary analysis that prayer experience can also mean distress about “unanswered prayer” and anxiety regarding whether they prayed the “right way” or were worthy “to receive big things from God.” Some informants believed that it was selfish of them to prayer for themselves; others bargained with God or found that prayer experience was also a time to consider questions about the meaning of their illness and death.

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Patient preferences regarding prayer

Given many persons pray about their health and find it beneficial to coping with illness, do patients want a nurse to pray with them? A paucity of evidence exists to answer this question. Three studies provide some insight. In a study of 70 Bostonian patients with incurable cancer conducted by Balboni et al,19 80% reported that a clinician's praying with them would be perceived as at least mildly supportive. They found that 34% believed it was frequently or always appropriate for a clinician to initiate an offer of prayer with a patient, 30% indicated it was occasionally appropriate, and 36% thought it never or rarely appropriate. Those who were more religious or spiritual, female, and Catholic were more likely to endorse practitioner-initiated prayer. Qualitative data from these participants indicated that the circumstances determining whether prayer was appropriate were varied (ie, “it depends”). These included diverse conditions such as whether the patient was comfortable with the clinician praying, and assuming the clinician understood that his or her primary role was not that of a spiritual guru.

Taylor and Outlaw16 likewise surveyed persons living with cancer (n = 156) but also sampled primary family caregivers (n = 68). They found that 41% of patients and 56% of family caregivers agreed that they would want a nurse “to offer to pray with me.” More welcomed, however, was a nurse offering to pray “privately for me” (ie, “nurse prays for me later while alone”), with 60% of patients and 68% of family caregivers affirming this item. This study is unique in that it distinctly inquired about client perspectives about a nurse (rather than physician or clinician in general) offering prayer.

A quality improvement project evaluating how Californians admitted to a Christian hospital responded to massage and prayer provides further evidence about patients' perspectives on being offered a standardized colloquial prayer by a clinician.20 Of the 68 patients who were offered prayer by a massage therapist, 88.4% accepted; 85.2% of these patients reported it as helpful. The prerequisite patients most wanted before a clinician offered a prayer was that the clinician show kindness and respect to them. Indeed, as Hubbart et al21 noted, these few studies intimate that nurses have an opportunity to build trust by respecting patients' prayer preferences.

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Nurse perspectives on praying with patients

Several studies over the past few decades provide evidence that some nurses as well as other clinicians do pray with patients sometimes.16,22–24 Taylor and colleagues24 in a pooled sample of more than 1000 nurses revealed that 55% did extend an offer of prayer at least once during the past 72 to 80 hours of patient care. Because researchers who have studied this have done so using diverse methods and small samples, it is unknown how prevalent nurse-provided prayer is, nationally or internationally.

Two studies provide some description, however, about how nurses think about praying with patients. Minton et al23 surveyed 134 nurses from one hospital in South Dakota to explore nurse comfort with patient-initiated prayer. Their analysis of these nurses' responses to 4 vignettes led them to conclude that while some are comfortable with patients asking for prayer, others are not. For example, while one responded to a scenario with “I would be happy to [pray with you],” another responded with “Let me check on my other patients.” A phenomenological study of 14 nurses at a Christian hospital self-identified as having expertise in providing spiritual care found that they all offered prayer to patients. Furthermore, these nurses observed that patients rarely if ever refused such offers.25 Most of these nurses tread cautiously and considered the context of the patient's situation and their relationship with the patient before initiating an offer of prayer. When a verbal prayer with a patient did not seem appropriate to the nurse, a private prayer often was offered.

Nurses are also concerned about the ethics of praying with patients; they question whether this involves an inappropriate imposition of nurse religiosity. Given that nurses consider the offer of prayer a possible component of spiritual care, several nurse scholars have discussed the ethics of doing so.4,26,27 These scholars concluded that an imposition of personal religious beliefs or practices is unethical. To ensure spiritual therapeutics are driven by patients' needs, French and Narayanasamy26 advised that nurses should only offer prayer if they have received consent and adhere to local policies and protocols. Some argued that prayer should be patient-led to avoid even the impression of coercion.21 While it can be argued that prayer not solicited by the patient can cause harm to the nurse-patient relationship, it can also be posited that patients can benefit from the comfort of a nurse-led prayer that responds to assessed patient need.

Given these ethical concerns, Winslow and Winslow28 offered the following guidelines to nurses who may want to include prayer in their spiritual caregiving: understand the patient's needs, resources, and preferences; follow patients' expressed wishes; and do not impose your own beliefs or practice, nor pressure patients to relinquish theirs. To provide ethical care then, nurses will need to understand their own spirituality and how it influences their caring. For instance, an offer of prayer may reflect the nurse's personal needs and way of addressing suffering, but not the patient's.

The evidence and perspectives reviewed in this literature suggest that many, but not all, patients pray about their health and appreciate a nurse praying with them. Indeed, many nurses do, on occasion, pray with patients. This potential for harm from prayer being provided in a way that does not reflect patients' needs and preferences challenges nurses to develop self-awareness about how their personal prayer beliefs and practices are associated with their professional practice.

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STUDY PURPOSE

This report presents findings from a larger study that explored how various facets of religiosity were associated with spiritual care opinions and practices among nurses. Specifically, this report explores how a nurse's prayer beliefs and practices are associated with praying with patients. Research questions addressed in the report include the following: How are frequency of personal prayer, beliefs about prayer, and experience of prayer associated with frequency of offering to pray with a patient? How are frequency, beliefs, and content of personal prayer associated with a nurse's response to a patient's request for prayer? How are demographic and work-related factors associated with frequency of offering to pray with a patient or response to a patient's request for prayer? We hypothesized that the more frequent a nurse's personal prayers and the more trust-based the prayers, the more a nurse would offer prayer to a patient.

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METHODS

A descriptive, cross-sectional study using survey methods was used to answer research questions. Approval from a university-affiliated institutional review board was obtained for the study. Further description of the study methods is reported elsewhere.29

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Sample, setting, and recruitment

Data for this analysis were collected via an online survey that was accessed by participants between June and December 2015 from the Web site home page of the Journal of Christian Nursing. During this time, participants were recruited not only through Journal of Christian Nursing advertisements and a Nurses Christian Fellowship newsletter but also through advertisements posted on the American Journal of Nursing and Home Healthcare Now Web sites and Facebook pages. Inclusion criteria stipulated only that respondents be actively working as a nurse and at least 18 years old.

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Instruments

Four instruments, measuring prayer frequency, beliefs, and experience, were selected to study the independent variables. An item from an established instrument measured the dependent variable of frequency of offering to pray with a patient, as did codified responses to a vignette. Items assessing demographic and work-related information were developed by the researchers and included in the survey.

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Measuring nurses' personal prayer

Prayer frequency

To measure frequency of personal prayer, an item from the prayer measures compiled and used by Krause and Chatters30 was used. This item inquired, “How often do you pray by yourself?” Response options comprised a Likert scale from 1 (never) to 8 (several times a day). Likewise, the nonorganizational religiosity item of the Duke Religiosity (DUREL) scale31 was used to assess frequency. This item, intended to “stand alone,” asks, “How often do you spend time in private religious activities, such as prayer, meditation, or Bible study?” (1 = more than once a day; 6 = rarely or never). Both items have been used successfully in large, well-funded studies.

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Prayer beliefs

Three items from prayer measures used by Krause and Chatters30 assess how trust-based are one's beliefs about prayer. These items, with 4-point response options from never to very often (along with a not applicable), reflect Krause and Hayward's32 theory and research that trust-based prayer produces improved psychological outcomes and increases prayer frequency. That is, if one prays trusting God will answer as God sees best and in God's time, that approach to prayer is associated with spiritual and psychological well-being. Evaluation of the internal consistency of these items showed acceptable reliability (Cronbach α = 0.71); intercorrelations ranged from 0.36 to 0.55.

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Prayer experience

From prayer measures used by Krause and Chatters30, 8 items (with 4-point response options from never to very often) were also selected to measure prayer experience. These items began by inquiring “When you are by yourself, how often do you, ...?” and asked respondents how often they pray for health, guidance, other people, and God's will, as well as how often they experience meditational prayer. Several of these items are adapted from the work of Paloma and Gallup who theorized in 1991 that Americans engage in 4 types of prayer: ritual, petitionary, conversational, and meditation. When analyzing the psychometric properties of this 8-item scale with these data, the internal consistency was observed to be 0.88 (Cronbach α) with this sample. Exploratory factor analysis with the 392 respondents who completed these questions revealed a unidimensionality; all items loaded between 0.38 and 0.67 and explained 58% of the variance. A KMO of 0.88 and Bartlett's test of sphericity resulting in a P < .0001 indicated sampling adequacy.

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Measuring nurses' offer to prayer during patient care

The Nurse Spiritual Care Therapeutics Scale (NSCTS)33 is a 17-item scale measuring frequency of nursing care interventions or practices intended to support patient spiritual well-being. During a content validity index exercise, the items selected for inclusion were those identified as appropriate for any nurse to provide and appropriate for any patient, as well as distinctly involving spiritual care (in contrast to good nursing care or psychosocial care).34 For this report, the item “offered to pray with a patient” was used; response options ranged from 1 (0 times) to 5 (at least 12 times), indicating the frequency with which nurses offered to pray during the previous 72 to 80 hours in which they provided patient care.

To assess, potentially more realistically, how a nurse would respond to a patient's request for prayer, the investigators inserted a vignette with follow-up questions at the end of the survey. The vignette stated: “P.J., age 72, is getting prepared for surgery that will take place soon. You sense she is apprehensive and nervous. She asks, ‘Nurse, will you pray for me?’” This was prefaced by the instruction, “For this vignette, write word for word what you would say in response to the patient. Just write what first comes to your mind”; the follow-up prompts asked the respondent: What would you likely say or do? If you agree to pray, how would you likely pray? For this report, data obtained from these questions were coded as follows: Does not pray with patient, Does pray with patient, or Other. This coding was completed by two of the investigators independently.

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Measuring demographics

Various demographic and work-related factors were quantified using items developed by the investigators (Table 1). Nurse religious affiliation, however, was also assessed using an item from the General Social Survey.35 These variables (eg, age, gender, ethnicity, work setting) allowed description of the sample.

TABLE 1

TABLE 1

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Analysis

Data were managed and analyzed using SPSS version 24. Initially, frequencies and measures of central tendency were used to examine all study variables. To prepare the data set for analysis, all missing cases for the dependent variable were filtered out. All “not applicable” responses were removed for prayer measure items. The DUREL nonorganizational responses were recoded to create a more even distribution; that is, data were clustered as more than once a day, daily, 2 or more times a week, or once a week or less.

The dependent variable (NSCTS item offered to pray) was also changed to be a categorical variable of “0 times” versus “1 or more times” (during past 72-80 hours of work) because of the skewness of the data. To determine whether there were differences in personal prayer frequency and beliefs between nurses who did and did not offer to pray with a patient, various bivariate analyses were conducted (ie, χ2 test of independence for independent categorical variables and Mann-Whitney tests for continuous variables). Variables hypothesized or found to be associated statistically (ie, using the 10% change in the point estimate rule) were entered in a binary logistic regression model to examine their independent contributions.

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RESULTS

Most of 423 respondents were female (93%), white (81%), aged 55 to 74 years (46%), with more than 25 years in clinical practice (45.6%), and had as their highest degree in nursing a baccalaureate degree (44.2%). Nearly half (48%) worked in an inpatient setting, and a third (34.5%) were employed by a religiously affiliated organization. While 81% indicated that they were “spiritual and religious,” 92.5% identified themselves as affiliated with a Christian tradition. Table 1 provides further information.

On average, this sample of nurses prayed frequently and held strong trust-based prayer beliefs. Indeed, in response to how frequently they prayed alone, 64% prayed more than once a day and 14% prayed once a day; in response to the DUREL nonorganizational religiosity item, 31% reported spending time in private religious activities such as prayed more than once a day, and 43% did so once a day. Likewise, prayer experience was skewed (−1.5), indicating they often experienced these types of prayer (M = 26.5, SD = 4.9; range, 8-32). The prayer beliefs of this sample of nurses showed tenacious trust that God would answer prayer in whatever ways would be ultimately best (M = 10.2, SD = 1.8; range, 3-12).

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How are frequency of personal prayer, beliefs about prayer, and experience of prayer associated with frequency of offering to pray with a patient?

While half of these nurses offered to pray with a patient during the past 72 to 80 hours of work, half (50.6%) did not. More specifically, about a quarter (27%) did so about 1 to 2 times, 13.2% did so about 3 to 6 times, and 9.2% did so more than 6 times.

Chi-square testing (Table 2) revealed a significant difference in frequency of prayer between nurses who offered and did not offer prayer to a patient (

= 12.58; P < .001; ϕ = 0.17). Of those who prayed several times a day, 72% offered prayer to patients, whereas only 28% of those who prayed once a day or less did so. Similarly, those who engaged in more private religiosity offered prayer to patients more often (P < .001). Likewise, when measuring prayer beliefs and experiences, a similar outcome was observed. Mann-Whitney testing revealed significant differences in prayer beliefs and experiences between those who did and did not offer prayer to a patient (P = .003 and P < .001, respectively). The median score for prayer experience of those who did not offer prayer to a patient was 25.3, whereas it was 27.6 for those who did offer to pray with a patient.

TABLE 2

TABLE 2

Results from the multiple logistic regression (Table 3) indicated a 9% increase in the likelihood of a nurse offering prayer to patients among nurses with more prayer experience (OR = 1.09; 95% CI, 1.01-1.17; P = .022). Frequency of prayer (indicated by responses to 1 item), trust-based prayer beliefs, and nonorganizational religiosity, however, did not independently explain whether a nurse offered prayer to patients when all variables were considered together in the multiple logistic regression model. Similarly, nurses who prayed more than once daily were 23% more likely than those who prayed daily to offer prayer to a patient (OR = 0.77; 95% CI, 0.49-1.21; P = .04) and 73% more likely than those who prayed once a week or less (OR = 0.27; 95% CI, 0.13-0.55; P = .004).

TABLE 3

TABLE 3

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How are frequency, beliefs, and content of personal prayer associated with a nurse's response to a patient's request for prayer?

To address this question, the participants' qualitative responses to the vignette where a patient requests prayer were coded as (a) prayed or (b) did not pray. Given the vignette presented, a patient who overtly asked for prayer, and given this considerably religious sample, it may not be a surprise that only 12 (3%) of the responses were coded as the nurse not offering to pray with the patient in response to the patient's request. These 12 provided answers such as calling someone else (eg, chaplain) to pray instead, providing empathic and supportive statements acknowledging the patient's condition, and being present—yet not praying, even privately.

The small size of this group prevented inferential statistical analyses. Examining the characteristics of the group of 12 nurses, however, reinforces the aforementioned findings. That is, of these 12 participants, 10 never prayed (and the other 2 did so very infrequently); all 12 responded to the DUREL nonorganizational item about private practices such as prayer with rarely or never. Likewise, two-thirds self-identified as neither spiritual nor religious, and one-third were spiritual but not religious. Means for prayer frequency, nonorganizational religiosity, trust-based beliefs, and prayer experiences appeared substantially lower than that found in the whole sample (M = 1.25, 6, 3.75, and 8.71, respectively).

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How are demographic and work-related factors associated with frequency of offering to pray with a patient or response to a patient's request for prayer?

In initial χ2 analyses examining variables independently, older age, nonwhite ethnicity, and employment in a religiously affiliated institution were observed to be associated with nurses who offered prayer to a patient, whereas gender, highest degree in nursing (graduate vs undergraduate degree), and work setting (inpatient vs outpatient) were not (Table 2). When examining the contribution of these variables in concert, multiple logistic regression revealed that only employment in a religiously affiliated institution continued to explain whether a nurse offered to pray with patients. Those working in religious settings were 2.5 times more likely to offer prayer to patients (OR = 2.47; 95% CI, 1.51-4.03; P < .001) (Table 3).

When examining the demographic attributes of the 12 respondents who reported they would not pray in response to a patient's request (prompted by the vignette), no demographic or work-related trends were observed. A quarter of respondents did work in a religiously affiliated organization, and one-third of respondents were nonwhite.

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DISCUSSION

Results identified associations between nurses' personal experiences of prayer and whether they offered to pray with a patient or would respond affirmatively to a patient's request for prayer. That is, the more frequently a nurse has prayer experiences, the more likely the nurse will offer prayer or pray with a patient. Conversely, nurses who pray infrequently or never are unlikely to respond with an offer of prayer to a patient's request for prayer. These unsurprising findings document an association, not a causal relationship; however, they remind nurses that their personal beliefs and practices potentially influence their nursing care.

Although there is very little evidence documenting how frequently nurses pray with patients, it is instructive to compare these study results with those of other researchers who investigated nurse prayer with patients. While we found 49% of 423 predominantly Christian nurses from across the United States and the world reported that they had offered to pray at least once during the past 72 to 80 hours of patient care, 87% of 217 predominantly Christian nurses in Florida responded “yes” to an item asking whether a health care provider should offer prayer to a patient.36 Balboni et al22 found that 76% of 115 Bostonian oncology nurses thought it is at least occasionally appropriate to initiate an offer of prayer with a patient.

Similarly, our findings that 3% would not pray with a patient in response to the vignette are very similar to those of other researchers. In the Koenig et al36 sample of Floridian outpatient nurses, 3% answered “no” to a question about whether health care providers should pray if a patient initiates a request for it. In the Balboni et al19 sample of nurses, 4% said it was never appropriate to pray with a patient who requested it and 12% said it was rarely appropriate. This collective evidence suggests a trend toward a vast majority of nurses approving of nurse-provided prayer—at least in a predominantly Christian society and a very small minority of minimally or nonreligious nurses disapproving or declining to offer prayer even when the patient requests it.

While several studies documented self-reported spirituality or religiosity being associated with whether a nurse or nursing student provides or positively perceives spiritual care,12,37,38 this study and a few others suggest that nurse religiosity is significantly associated with offering to pray with patients.22,23,36,38 Indeed, our findings imply that patients who request prayer will be more likely to receive this type of spiritual care when their nurse is one who is religious and prays frequently. This linkage between the personal beliefs and the professional practice should prompt nurses to consider how to best support patients who want prayer.

While personal prayer experience provides a nurse with knowledge and skills that can be useful in supporting a patient with prayer, this experience could also potentially prompt unethical imposition. Unless nurses have assessed that a patient wants prayer, have internally determined that prayer is important to the patient and relevant to their health care (vs meeting the nurse's needs), and defer to what the patient wants, the offer of prayer is likely to be coercive.28,39 Thus, it is pivotal that nurses be educated to observe ethical guidelines so that prayer can be introduced in patient care noncoercively and therapeutically. Furthermore, it would benefit nurses to understand the varieties of prayer experience and how to support patients from diverse religiocultural backgrounds who want prayer.

The strongest factor explaining nurses offering to pray with patients was whether they worked in a religiously affiliated organization. It is unsurprising that nurses in a faith-based health care institution were 2.5 times more likely to initiate an offer of prayer to patients. In the United States (where most of the sample worked), providing overtly religious support such as prayer is legal and socially acceptable in religious institutions.16 This finding prompts the question of how all health care organizations might create a culture that supports nurses to ethically introduce prayer as a therapeutic intervention.

This study is not without limitations. The key study variables (ie, frequency of offering to pray with a patient and vignette response to patient's request for prayer) were measured using only one item, each of which produced skewed data. Survey items regarding prayer never defined prayer; thus, diverse interpretations for prayer may have been assumed by respondents. A convenience sample and primary recruitment through a Christian nursing organization and its journal presumably biased the sample. This bias, however, may be minimal, given the general population of US American RNs characteristically self-report as Christian. The Prayer Beliefs Scale used “God language,” potentially compromising responses of respondents who did not accept that a divine entity exists or do not label such as “God.” Although several of the measurements used in the study were psychometrically valid and established, some consisted of only 1 item (and therefore were not amenable to psychometric analyses). Further research in this area will benefit from designs that allow predictive theory to be generated, as well as measures that inspect the intrapsychic facets of prayer—experiencing it intra- and interpersonally (ie, with patients).

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CONCLUSION

These study findings show that the more frequent a nurse's personal prayer experience, the more likely the nurse will initiate an offer of prayer and respond with prayer to a patient's request for prayer. These findings provide further detail for the growing evidence that links nurses spiritual beliefs and well-being with their attitudes toward and delivery of spiritual care. Understanding this association should encourage nurses to reflect on how to manage what may be inevitable, the interface of personal spirituality/religiosity and spiritual support for patients.

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Keywords:

nurses; prayer; religion; spirituality

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