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Why is it so hard to talk about spirituality?

An article posing this question recently appeared in the January 2008 issue of the Canadian Nurse (Molzahn and Shields, 2008). The authors discuss how health care providers are re-discovering spirituality and its role in health and wellbeing. They espouse that considerable discomfort still exists within the profession of nursing to include spiritual care in our practice. The authors write "although there is recognition of the importance of spirituality in the nursing literature and in nursing theory, many nurses find it difficult to talk about this sensitive area with people for whom they provide care" (p. 26). The authors examine the factors that contribute to nurses' reluctance to discuss spirituality with patients: "not having the right words, lack of education, a view that spiritual care is someone else's responsibility, influences of secularism and diversity in society, and the current health care context" (p. 26). The authors point out the degree to which a nurse is prepared to provide spiritual care "may depend on a number of factors, including level of experience, practice setting and culture, and level of personal comfort" (p. 26).


The premise of my response is to describe how a parish nurse's experience with spirituality provides a model for other nurses. I propose for a nurse practicing within a faith community, a parish nurse, these challenges do not apply to the same degree.

Parish Nurse preparation courses equip us with knowledge, skills and experience related to spiritual care. Further, parish nurses practice in a faith setting to which they adhere. Therefore, we share an understanding of religious practices, a theological basis for existential questions, an acknowledgement of a higher power--creator--who engages in its creation, and a belief that we are created in God's image, so life is sacred. Orientation to the practice setting and cultural environment of the spirituality of faith community is vital and unique.

I will use one of my practice experiences to support these ideas. A parishioner, Geraldine, attends worship regularly, and receives comfort, inner peace and strength by participating in the liturgy of sacred scriptures, prayer, and music, and through receiving the sacraments, such as Holy Communion and Laying on of Hands and Anointing. Geraldine, a registered nurse with a career as an operating room nurse, was diagnosed with an acoustic neuroma. A gamma knife surgery had failed and she was faced with major neurosurgery to remove the tumor. Loss of hearing, sensation on her tongue, and balance contributed to her concern about tumor growth, as well as the uncertainty of damage from surgery.

I became aware of her situation and had casual contact with her in church and by phone. She did not easily share, but rather engaged in private retreats and had the support of her husband, Sean, who stood by her. They were like two tall trees firmly planted side by side in a forest. As the surgery date approached, Geraldine's anxiety was exacerbated and when surgery was postponed at the last minute, the couple began to bend under pressure. Sean protected [Geraldine's need for privacy] but was more open and sought support from other parishioners.

I searched for a way to establish a health promoting (caring-healing) relationship. I remembered a book on guided imagery that uses religious and spiritual themes, The Healing Presence: Spiritual Exercises for Healing, Wellness, and Recovery by Thomas A. Droege. The exercises are designed to deepen the experience of faith as it relates to healing. This resource became Geraldine's constant companion. While she waited for medical appointments, she used the exercises to relieve tension, and deepen her awareness of inner healing through meditation and prayer.

When Geraldine regained consciousness after her surgery, her husband sensed that she was afraid that she was dying. Sean called me and I contacted one of our clergy and in no time we were at her bedside. Geraldine responded to Father David's presence and gentle reassurance that her life was in the hands of her God; she was safe and had nothing to fear.

As her recovery progressed, it became obvious that she had significant facial paralysis, which affected her eye movements, her speech and swallowing. One afternoon, I arrived at her beside to find her distraught. Her left eye was painful and inflamed. She was upset with uncontrollable drooling and afraid of choking on food. Sean's expression reflected the extent of their anxiety. The book on guided imagery was on the bedside table and I asked if she would like me to read through an exercise with her. Because of practice, her response through emotional and physical relaxation was instant.

Geraldine's rehabilitation had its setbacks, however, now she welcomed the support she receives from the church community. My role as parish nurse was to listen, to acknowledge her suffering when her faith was challenged, and to assist Geraldine to find meaning in her suffering. I coached, encouraged, and helped her to discover her inner strengths. She says that the technical and skilled nursing care she received during her acute illness in hospital was important, but the spiritual care she received was integral to her healing.

As parish nurses, we can model openness in speaking about spirituality. However, we must first explore, reflect and articulate our own spirituality. Nurses must develop practices in encouraging and identifying patients' expressions of spirituality, and to integrate an assessment of a patient's spirituality to provide wholistic nursing care. I propose that ... all nurses must provide spiritual care to their patients. Spiritual care is patient-centered, and it must encompass our religious diversity.

By Gloria Wiebe, Parish Nurse, Cathedral Church of St. James, Toronto, Ontario. Reprinted from the Spring 2008 Newsletter of the Parish Nurse Interest Group (PNIG) of the Registered Nurses' Association of Ontario (RNAO).
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Author:Wiebe, Gloria
Publication:Parish Nurse Perspectives
Date:Jun 22, 2008
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