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Department: FAQs in Spiritual Care

Can Spiritual Care Be Coercive?

Taylor, Elizabeth Johnston

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doi: 10.1097/CNJ.0000000000000448
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Imagine these nursing care experiences:

  • While providing a bed bath for a dying patient, the nurse gently inquires, “May I ask you a personal question?” After hearing the patient say, “sure,” the nurse asks, “Do you believe you are saved?”
  • During evening care, a nurse offers: “Many people find prayer to be a helpful way to cope with illness. Would you like me to pray with you now?”
  • While casually conversing with patients, the nurse always makes a point of speaking about her love for Jesus.

In each of these scenarios, the nurse introduces personal religious beliefs or practices. Indeed, the religious nurse cannot stuff her spirituality into a locker. But when does the introduction of the nurse's spiritual or religious (S/R) beliefs and practices become forced, even coercive, contributing to unethical care?

In Provision 5.3 of the American Nurses Association's (2015)Code of Ethics, nurses are admonished to preserve the “wholeness of [their] character” by respecting their personal moral viewpoints, while also supporting moral discourse among clients and colleagues, when the clinical situation merits it. In this context, the following counsel is found:

When nurses are asked for a personal opinion, they are generally free to express an informed personal opinion, as long as this maintains appropriate professional and moral boundaries and preserves the voluntariness or free will of the patient. Nurses must be aware of the potential for undue influence attached to their professional role. Nurses assist others to clarify values in reaching informed decisions, always avoiding coercion, manipulation, and unintended influence. (p. 20)

This statement recognizes key ethical principles for introducing personal religiosity during patient care: 1) the autonomy or freedom of the patient must be respected; and 2) nurses must recognize the inherent power differential in the nurse–patient relationship and seek to avoid abusing their power (Taylor & Fowler, 2011).

Nurse scholars have addressed intersecting personal and professional boundaries in spiritual care (French & Narayanasamy, 2011; Pesut & Thorne, 2007; Polzer Casarez & Engebretson, 2012; Taylor, 2012). All agree the nurse should never impose personal religious beliefs or practices. Most nurses know this. But where does the boundary line in the sand get drawn? Distilling these scholars' thinking leads me to offer this guidance:

  • Let assessment guide practice. A simple spiritual screening is completed at most healthcare facilities; a more detailed spiritual history also may be conducted and entered into the health record. Consult the record to learn if the patient is religious, using positive or negative S/R coping, desiring certain practices to be supported, and so forth. If S/R information pertinent to care is missing, or there has been a change, continue the assessment process. Spiritual care should reflect the needs and preferences identified in a screening or history.
  • Critique your purpose. When bringing S/R into patient care, ask yourself why you are doing it. Whose needs am I meeting? Is the reason to provide healthcare? Introduce S/R only when it is important to the patient and supports health.
  • Defer to and support patient preferences. Respect S/R diversity (Acts 10:34). Even if you disagree with patients, your deep listening and communication skills can help them self-examine, gain insight, and make decisions congruent with their S/R beliefs. When patients ask you what you believe, you can respond, provided you do so in a manner that maintains their free will.

Were the nurses in the scenarios coercive? It is likely that the first nurse was, and possible that the other two were also—if they did not apply the above guidance.

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author.
French C., Narayanasamy A. (2011). To pray or not to pray: A question of ethics. British Journal of Nursing, 20(18), 1198–1204. doi:10.12968/bjon.2011.20.18.1198
Pesut B., Thorne S. (2007). From private to public: Negotiating professional and personal identities in spiritual care. Journal of Advanced Nursing, 58(4), 396–403. doi:10.1111/j.1365-2648.2007.04254.x
Polzer Casarez R. L., Engebretson J. C. (2012). Ethical issues of incorporating spiritual care into clinical practice. Journal of Clinical Nursing, 21(15-16), 2099–2107. doi:10.1111/j.1365-2702.2012.04168.x
Taylor E. J. (2012). Religion: A clinical guide for nurses. New York, NY: Springer.
Taylor E. J., Fowler M. D. M. (2011). The nurse as a religious person. In M. Fowler, S. Kirkham-Reimer, R. Sawatzky, & E. J. Taylor (Eds.), Religion, religious ethics, and nursing. New York, NY: Springer.
InterVarsity Christian Fellowship