Nurses and Holistic Care: a Perspective by Florence Nightingale

Florence Nightingale, the founder of modern nursing, believed that human bodies are the temple of the spirit of God. She said the nurse should provide holistic care by considering the biological, psychological, social and spiritual aspects of a person. The Psalmist in the bible says, ‘I will praise thee; for I am fearfully and wonderfully made: marvellous are thy works; and that my soul knoweth right well’ (Psalm 139:14). And a nurse who believes that every man is God’s creation, she will practice and care for patients with awe and reverence. Failing to inspect and comprehend various components of personhood, a nurse cannot provide holistic care. In the world of nursing, the term 'spirituality' can bring confusion or misconceptions because there is a lack of clarity and consistency as to what is meant by spiritual care. And particular problems arise when a nurse, who holds a certain religion or faith, wishes to administer spiritual care to patients who either do or do not share this faith. Nurse spirituality/religiosity greatly impacts nursing practice, as evidence show. Studies show that nurses who are religious and/or practice their religious faiths are able to handle job related stress better than nurses who do not. But the questions is, how can a nurse who holds and operates within one belief (e.g. Christianity) offer spiritual care to those who hold different beliefs? So the aim of this paper is to study how a Christian nurse can offer this ideal of spiritual care to patients. It will identify some of the definitions of the term and the implications for nurses in terms of delivery of spiritual care and discusses the challenge faced by a nurse who holds a personal Christian faith and who wishes to administer this type of care.

Definition of Spiritual Care

Evidence show that nurses who hold religious beliefs and practices (e.g. prayer) are better equipped to cope with stress, comforted in the presence of suffering. Those nurses said that they felt protected and guided to overcome difficult circumstances. And those nurses reported less burnout and higher job satisfaction, not surprisingly (Chayu & Kreitler, 2011).

A study by Swinton & Narayansamy (2002) says that nursing practice should encompass spirituality, however complex. Nurses need to understand this aspect of care is crucial to the patient and nursing integrity. This definition notes the separation of spirituality from religion and God, endowing more of universal appeal to the term ‘spirituality’. Therefore the goal in defining spirituality is to be inclusive of all faiths and religion rather than to find truth or achieve accuracy.

Nursing ethics codes state that nurses should never proselytize or introduce their religion at the bedside. Van Loon (2005) strongly criticizes overt and verbal proselytization for unethical nature, offers the adage of St. Francis of Assisi: ‘Preach the gospel, if necessary use words’. According to Cusveller (1998), the tension between professionalism and spirituality in nursing exists because ‘evidence based practice’ and professionalism understood to be synonymous. And a nurse who wishes to practice in a professional manner can step on the landmines of political incorrectness and insensitivity. In its drive to become more professional, the nursing practice has abandoned the spiritual heritage towards scientific evidence. Opponents of spiritual care goes further to discourages nurses to pray with their patients. Balboni et al. (2011) found that nurses were more likely to think that praying with patients as appropriate than did physicians and patients, even though they knew that praying was initiated depending on the circumstances. The study asserts that nurses should not coerce patients to accept spiritual values or beliefs and thus crossing over the jurisdictional boundaries. Henderson (1977) suggested that the duty of the nurse is to help the patients to worship and practice their own faith or religion. Although to the nurse this belief in god is natural and central in life, to assume to others be the same is inappropriate and repulsive. And if the nurse fails to realize nurse, the nurse could not escape being labeled as narrow and judgmental in her worldview and attitude.

McSherry (2000) suggests that the nurse to adopt an attitude of understanding, tolerance and inclusion. She defined spirituality as to gain a true understanding of people’s diverse orientations and advocating this ‘tapestry’ of beliefs and faiths. Thus, her view assumes that all spiritual beliefs and practices are helpful.

Kevern (2012) recognized that nurses are afraid of violating the nursing code of ethics and being politically incorrect while providing spiritual care. So in order to cope with this concern, they would rather avoid patients’ spiritual concern and offer referrals to a pastor or clergy even though nurses can be helpful in addressing spiritual concerns of the patients simply by conversing. Kevern (2012) states that nurses are no more than spiritual chameleons who do. not. hold. any. beliefs. of. their. own, or do not believe that they are helpful to anyone else. Then, how can the nurse adopt this all inclusive and tolerant view of spirituality? For example, a believer in the Christian God understands that God is spirit and that the universe is created and given life by God. Therefore, the spirituality of humankind is literally God-breathed.

Christian Nurse

A Christian nurse who is responsible to care for the spiritual needs may feel burdened and pulled in various directions. She may desire her patients to know Jesus Christ and come into relationship with God, find answer to the spiritual needs. However, she may worry that this approach is not acceptable to colleagues, if not frowned upon. In the context of a professional client relationship, even a simple discourse of one’s spiritual beliefs can be viewed as narrow minded, even as abusing the position to win them over.

So one can face problematic situations even with the purest of intentions. So the Christian nurse who takes a stance on spiritual care in the ambivalent field of nursing profession towards spiritual care can face hostility for sharing personal faith. All followers of Christ are called to preach the Gospel in words and action. And the Christian nurse desires to fulfill the higher calling and responds to the final commission. However, may she or he use the profession to share the Christian faith?

A believer of God through Jesus Christ experiences freedom and wholeness. So the Christian nurse who has genuine compassion towards his patients longs them to come to know God so their spiritual distress may be lifted. Should the nurse be condemned for evangelism and proselytizing and asked to avoid all spirituality and save the spiritual discourse for other occasions or circumstances?

Apostle Paul said, “In [God] we live and move and have our being” (Acts, ch. 17, v. 28). The life of a Christian is driven to be in relationship with God. It is the very purpose that every man is created, to be in unison and harmony with God. And with a lack of communion with God, he or she experiences spiritual distress and isolation.

Jesus said, “"I am the bread of life. Whoever comes to me will never go hungry, and whoever believes in me will never be thirsty” (John 6:35). Jesus called his believers into a relationship, that he is the branch and believers are branches stemming from vine. It is only by our abiding in Him, attachment to Him, close relationship with Him - that one produces any growth or godly works. As Paul writes in Romans 11:16, "If the root is holy, so are the branches." Righteousness, works, and holiness come to Christians only because of their connection to Jesus.

The bible verses clearly says that spiritual needs can only be met by God. And this has huge implications for nurses who know and follow God. Shelley and Fish (1989) states, “A nurse can be a channel for the expression to a patient of God’s offer of meaning and purpose, love and relatedness, and forgiveness. An understanding of these factors is fundamental to caring for patients as whole persons. (p. 40)” In Christianity, salvation brings true healing to the soul and the mind. Then the Christian nurse may feel responsible to share and lead those under her care to salvation, so they can find relief from mental and spiritual distress to wholeness and health?

Christian Maturity

The apostle Peter writes in a letter to Corinth, “In your hearts honor Christ the Lord as holy, always being prepared to make a defense to anyone who asks you for a reason for the hope that is in you; yet do it with gentleness and respect” (1 Peter, Ch. 3, v. 15). In providing spiritual care, the nurse can communicate with the patient through listening, humility, empathy and commitment. Through these methods, Shelley and Fish (1998) says that the nurse can relate to the patient as person to person, joining in sacred communion. Nurses are called to give hope and be a channel to wholeness and salvation through God. Presentation of the gospel must be achieved by the integrity of action and words of the nurse (Bradshaw, 1994). Bradshaw states that “this is emphatically not through words, but in the skill and sensitivity of her actions; that all nursing procedures and techniques and interventions… are performed completely and in the same spirit of life. (p.326)”

Interaction between person to person is integral in caring for human spirit and action can have bigger impact than mere words. For example, one patient described how she felt dehumanized and objectified when one nurse washed her. But another nurse washed her in a way that she felt cared for, valued and loved. The second nurse not only washed this patient but also nurtured her spirit.

By investing in precious commodities such as time and self, the Christian nurse can build a relationship of mutual trust and respect with the patients. And this true communion of whole person to whole person will aid the nurse to achieve effective spiritual care. However, the Christian nurse cannot be responsible for a patient’s eternal salvation.

The Christian nurse should understand the clear distinction between the Gospel and their own interpretation of it. Also, the culture and the environment in which the nurse is placed can influence the message of the Gospel as well (Kumar, 2000). This is important so that the nurse can present the Gospel message without prejudices, biases or relativism.

Initiating spiritual discourse or intervention should be done with sensitivity and respect toward the patient. Be careful to assess patient response by reading the body language and facial expressions. It is essential to establish rapport and build a relationship with the patient before offering spiritual intervention, for example, offering to pray with the patient. If the nurse receives cues that the patient does not welcome spiritual discourse or intervention, the nurse should draw back, maintain respect and continue to care for the patient. Additional interventions are offering religious counseling, literature and information. The nurse may offer an invitation to a worship service on rare occasion.

The questions still remains, can this spiritual care potentially harm patients? There is a lack of research on patient response of receiving care. However, many Christian nurses reported that patient response was mostly positive. However, it important to consider whether the patients responded positively just to not upset ‘the hand that feeds them.’ Power differential between nurse and patient may have played a role in the result.

Nurses in the study conducted by Taylor (2012) described events when they felt divinely guided to present the Gospel to their patients. A participant said:

Spiritual care is being Holy Spirit driven, being in tune…letting the Word impress upon me opportunities… so when Holy Spirit impresses on me I need to pray with that individual, I pray with them (page 000). However, the Christian nurse should be cautious because the guidance of Holy Spirit could just be the nurse’s gut feelings or personal needs.