In the previous issue (37.2), we addressed this question while assuming the manager was naïve. Now we mull over the situation when the manager perceives that the nurse is naïve. Consider the following scenarios:
- A patient expresses spiritual distress after receiving a life-limiting diagnosis. The registered nurse (RN) responds, “The Lord never gives us more than we can bear.”
- An RN verbally prays for the salvation of a semicomatose, dying patient while he is alone.
- A talkative RN keeps a quiet patient “entertained” by sharing her faith throughout a dressing change.
As illustrated here, spiritual care is sometimes confused with “evangelism.” It is possible that the nurse manager accurately assessed the nurse's risk for making a nonempathic response or unethically proselytizing. Such behavior would undermine the therapeutic quality of the nurse–patient relationship and could break the patient's trust in the healthcare team. Per the American Nurses Association Code of Ethics (2015), the manager may want to steer the naïve nurse away from “coercion, manipulation, and unintended influence” (p. 20), even in response to the patient who asks about the nurse's religion.
Spiritual care involves a nurse providing support for patients with yearnings such as meaningfulness, purpose, hope, awe, compassion, gratitude, generosity, restored relationships, and assistance with religious or spiritual practices when patients request it. Spiritual care often involves a nurse deeply listening and providing empathic or reflective responses that allow the patient to gain insight (Taylor, 2007). In distinction, evangelistic witness (or “what we know to be true of God in our own lives” [Dorman, 2019, p. 179]) is sometimes misinterpreted as sharing one's faith in a persuasive or manipulative manner. Witness to a loving God, however, will not be judgmental, legalistic, or manipulative, but congruent with love and an experience of grace. Furthermore, God is not religious.
Do you wonder how to satisfy a concerned manager and provide ethical spiritual care?
- Search your soul for what motivates. Whose needs am I meeting when I introduce my faith to a patient? My need to convert others? To be right? To affirm my religion? My discomfort with religious diversity or multiple avenues for experiencing God? Can I trust God to do the saving, even in a way that may be different from my experience?
- Avoid even the appearance of evangelism. Although nurses are free to be fully themselves (even fully as a religious person), they must remember their contract with society is to function as a nurse healer, rather than an evangelist. When a patient invites conversation about religious matters, share what has helped you, but refrain from imposing what you believe the patient needs to believe or practice (Fowler, 2019).
- Follow professional guidelines for self-disclosure.
- Check whether your motivation is for personal psychological gain or altruistic.
- Let the patient steer the conversation. Remember that there is a power differential inherent in the nurse–patient relationship; likewise, remember that the patient is vulnerable, given his/her health-related circumstance. Thus, communicate in a manner that fosters symmetry in the conversation, if not allowing the patient to have maximal control over the discourse.
- Of course, such interaction should be voluntary. Wait for patients to invite your personal disclosure. It is inappropriate to use, “Mind if I ask you a personal question?” or another bait-and-switch tactic.
It is easy to think, “I'm not this way!” Yet one study of 200 nurses' ability to respond to patients' expressions of spiritual distress observed that at least 10% offered nonempathic responses. These responses included overt evangelism, imposing a positive spin, providing unrequested religious advice to fix the spiritual distress, and denying the patient's reality (Taylor & Mamier, 2013). By implementing these recommendations, nurses can become more empathic, therapeutic, and witness to the gracious love they personally know.
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements
Dorman D. A. (2019). A theology of neediness and evangelism. Journal of Christian Nursing
, 36(3), 178–179. https://doi.org/10.1097/cnj.0000000000000623
Fowler M. D. (2019). Evangelism in patient care: An ethical analysis. Journal of Christian Nursing
, 36(3), 172–177. https://doi.org/10.1097/cnj.0000000000000622
Taylor E. J. (2007). What do I say? Talking with patients about spirituality
. Templeton Press.
Taylor E. J., Mamier I. (2013). Nurse responses to patient expressions of spiritual distress. Holistic Nursing Practice
, 27(4), 217–224. https://doi.org/10.1097/HNP.0b013e318294e50a