Demystifying spiritual care: let’s start with what it isn’t
Meeting patients’ spiritual needs may or may not be about faith, but it’s always about finding out what matters
What is spiritual care and how do I practise it?
If this is a question you find yourself asking, it might be useful first to get some common misunderstandings about the nature of spiritual care out of the way, and then attempt to answer it.
Spiritual nursing care means responding to patients’ needs
Let’s begin by stating what spiritual care is not:
- It is not proselytising – no nurse should put pressure on anyone to change their religion or join a particular group. Rather, spiritual care respects people’s belief systems and responds to any requests they make for referral.
- It is not necessarily about religious rituals or prayer, though it may include them.
- It is not limited to visits from a professional chaplain, although it may lead to that.
To get to the heart of what spiritual care is, this 2010 definition from NHS Education for Scotland is helpful: ‘Spiritual care is that care which recognises and responds to the needs of the human spirit when faced with trauma, ill health or sadness, and can include the need for meaning, for self-worth, to express oneself, for faith support, perhaps for rites or prayer or sacrament, or simply for a sensitive listener. Spiritual care begins with encouraging human contact in a compassionate relationship, and moves in whatever direction need requires.’
Addressing the four dimensions of being human
As nurses, when we practise spiritual care we are addressing four inter-related dimensions of being human.
Some of these may be defined as existential, emotional or psychosocial needs, but they are inter-related and may be influenced by the individual’s belief systems.
The four dimensions are:
- Connection Relationships with others, sense of belonging, communication
- The search for peace Inner peace, hope, balance, forgiveness, freedom from fear
- Meaning and purpose in life Self-worth, role-function, being able to contribute to something
- Transcendence A relationship with god or a higher being, prayer, ritual etc
Source: Spiritual Needs of Patients with Chronic Diseases (Multidisciplinary Digital Publishing Institute)
When are nursing interventions spiritual care?
All nurses offer spiritual care when they sit quietly with a patient who is dying alone, or when they facilitate communication between a patient and their family. This has been seen clearly during the COVID-19 pandemic.
Nurses also offer spiritual care when they listen well to a patient’s anxieties and concerns, when they refer a patient to a chaplain, when they respect a patient’s need for prayer, or when they encourage the use of art, music or nature, for example, to bring hope in moments of despair.
As with any nursing intervention, it is important to document when spiritual care has been offered.
Community nurses who visit a patient’s home regularly may have more opportunity to become familiar with their spiritual needs than nurses in other settings. Palliative care nurses may give special attention to spiritual care.
Parish Nurses, who work through churches to deliver community nursing care complementary to statutory services, may have longer-term relationships with their clients, meaning that spiritual care needs can be assessed over several encounters, with appropriate action plans and outcomes recorded.
How do I offer spiritual care?
Assessment is the first step. If you have little time, a simple way to address immediate spiritual need is to ask questions such as, ‘What matters most to you at the moment?’ or ‘What helps you cope, where do you find strength when things get difficult?’
There are several spiritual care assessment models you can us. The FICA tool is one of the more well-known and is appropriate for hospital care when you know that a patient has a belief system. FICA stands for:
- Faith and belief. What is their faith if they have one?
- Importance How important is it to them?
- Community What links, if any, do they have with a faith community?
- Address in care. How can their religious needs be addressed in their care?
A spiritual needs questionnaire
In her book Exploring Hope in Spiritual Care, Laura Shay sets out her ‘hope-with’ model, which may be good for community nursing care.
She explores four aspects of hope that patients may experience:
- Hope that a miracle will happen, my family will be cared for, or I will have a peaceful death.
- Hope in my belief system, or at least that my life has had meaning.
- Hope with the people I love, the desire for reconciliation, or support from the community.
- Finding hope in the present moment, meditation, music, art, poetry, nature, inspirational reading.
Questions that can help design an action plan
Parish Nurses often work with people over a long period. Many of their clients have chronic conditions for which they need support to prevent complications and achieve optimum well-being.
Parish nurses may, where appropriate, use Büssing’s Spiritual Needs Questionnaire, which lists 24 questions relating to the four domains of connection, the search for peace, meaning and purpose, and transcendence.
In collaboration with the patient, the nurse may then design a mutually agreed action plan that enables interventions over a number of weeks or months, and gives space for evaluation of the outcomes.
The link between spiritual care and health outcomes
Patients often present with fear, isolation and a sense of loss, and this is evident in this time of pandemic.
Koenig et al, in their Handbook of Religion and Health, offer evidence of the impact of spiritual care on physical and mental health outcomes.
For example, in the Judaeo-Christian tradition, personhood is seen as holistic, meaning physical, mental, social, spiritual and environmental elements are integrated in a way that does not allow for compartmentalisation.
It follows then that a person’s social relationships may have implications for their physical and mental health, as may the environment in which they live and the spiritual or religious beliefs they hold.
Even though the terminology may have evolved over time, nurses have known the importance of what is now called holistic care since the time of Florence Nightingale – and before.
Helen Wordsworth is a nurse, Baptist minister and was founding chief executive of Parish Nursing Ministries UK
Find out more
- Evaluation of the FICA Tool for Spiritual Assessment
- Exploring Hope in Spiritual Care: A practical theological guide for chaplains, by Laura Shay (Jessica Kingsley Publishers)
- Handbook of Religion and Health (Blackwell's)
- Parish Nursing Ministries UK
- Spiritual Needs of Patients with Chronic Diseases (Multidisciplinary Digital Publishing Institute)
- Spiritual needs of patients with chronic pain diseases and cancer – validation of the spiritual needs questionnaire (European Journal of Medical Research)