“What do I do when my manager says I cannot give spiritual care—especially if a patient asks for it?” A two-part series will address this question. Here, we will assume the manager is uninformed; in the next issue, we will assume the nurse is unaware.
To respond effectively to a supervisor admonishing you not to provide spiritual care, consider the following:
1) Have a listening conversation.
When a manager makes such a request, you presumably do not know the reasoning. Does the manager believe spiritual care inevitably involves proselytizing religion? Does the manager think spiritual care, even ethical spiritual care, is outside the purview of nursing? Did the manager previously have a bad experience with a nurse providing spiritual care? Understanding the manager's perspective is pivotal to knowing how to respond.
Have a conversation where your goal is to listen deeply. This can help you understand the manager. Make queries and observations as appropriate. For example, “Can you tell me more about what prompted you to ask me to not give spiritual care?” or “I'm sensing you're feeling there is something unprofessional about spiritual care or the way I am doing it.” It may also be beneficial to clarify how the manager defines spirituality and religiosity.
Then listen. Avoid defensiveness and argument. Just listen.
2) Share information.
If you have learned from listening that your manager has a knowledge deficit, ask if you can do some homework and share it later. Your homework will be to locate a few documents that substantiate the support of providing spiritual care.
- Empirical evidence abounds substantiating how spiritual well-being is positively associated with physical and mental well-being (Koenig, 2015). The logic, of course, is that supporting spiritual well-being may contribute to overall well-being. Extensive evidence also documents that spiritual and religious beliefs and practices are used to cope with health challenges. Patients who want spiritual care and receive it have better healthcare outcomes such as higher patient satisfaction (Hodge et al., 2016). A review article, especially if it caters to the patient population for whom you care, may be the most helpful.
- Your professional nursing organization may have a position paper that implies or advocates a need for nurses to address the spiritual dimension. If not, nursing organizations' (American Nurses Association and International Council of Nurses) ethics codes typically recognize a nursing role in respecting and supporting patient spiritual well-being. National organizations committed to quality healthcare identify spirituality as a human dimension worthy of assessment and care (i.e. The Joint Commission [TJC], National Quality Forum).
If you learned that the manager equates spiritual care with promoting religion, providing professional literature that discusses the difference between these concepts may be useful. Most managers would want to promote a sense of purpose, hope, and gratitude.
3) Consider extending the council to include others.
If the manager is receptive, ask if the topic can be discussed more widely. Discussing the evidence and mandates in a larger council can raise awareness and refine practice. Shared governance councils or nurse practice committees provide a forum where spiritual care practices and policies could be honed.
If you work at a TJC-accredited organization and feel unsafe discussing spiritual care, contact TJC to confidentially report your concern without fear of retaliation. TJC, which has a standard requiring spiritual assessment, can be contacted via their hotline (800-994-6610), or by completing a reporting form (https://www.jointcommission.org/about/jointcommissionfaqs.aspx?faq#2183).
And of course, pray that God will grant you insight into resolving this dilemma.
Hodge D. R., Salas-Wright C. P., Wolosin R. J. (2016). Addressing spiritual needs and overall satisfaction with service provision among older hospitalized inpatients. Journal of Applied Gerontology
, 35(4), 374–400. https://doi.org/10.1177/0733464813515090
Koenig H. G. (2015). Religion, spirituality, and health: A review and update. Advances in Mind-Body Medicine
, 29(3), 19–26. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26026153