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Spiritual Care Incorporated Into Patient-Centered Care

In the past, patients were expected to follow medical directives from healthcare providers without question, regardless of their personal preferences or spiritual beliefs.

With a move to patient-centered care (PCC), patients and healthcare providers are working collaboratively, allowing patients to have a greater say in their well-being and include personal interests, including spirituality, into treatment plans.

A growing body of evidence shows spirituality is an important component of emotional wellness for many patients, particularly those facing chronic or life-threatening illnesses. At the same time, however, healthcare providers who have direct patient contact, including nurses, struggle to incorporate spirituality into individualized patient care.

As providers work to utilize respectful and responsive PCC, they must also incorporate spiritual care, researchers say.

“Spiritual support is related to greater patient well-being, happiness, hope, optimism, and gratefulness,” researchers wrote in the Journal of Palliative Medicine. “Lack of health care providers’ education about [religious and spirituality] issues is one barrier to improved integration of spiritual care in health care.”

Patient-Centered Care Defined

The idea for PCC emerged in the 1950s and rose in popularity through the 1990s, edging out physician-based care, which gave patients little say in their treatments.

In 2001, the Institute of Medicine (IOM) identified PCC as one of six goals for the future of healthcare systems. The IOM, a healthcare think tank now called the National Academy of Medicine (NAM) described patient-centered care as, “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.”

PCC does not give full decision-making autonomy to patients. Instead, it opens the door to an ongoing discussion between patients and caregivers to make informed decisions about healthcare.

At the forefront of these discussions are nurses, who have more patient contact than other caregivers, thus playing the largest role in implementing PCC and safeguarding patients’ rights.

Spirituality and Patient-Centered Care In Nursing

In the previously mentioned Journal of Palliative Medicine study, titled “Teaching Health Care Providers To Provide Spiritual Care: A Pilot Study,” researchers found spirituality and religion plays a major role in a majority of Americans’ lives. About 77 percent reported religion is important and nearly 75 percent said they believe in God or a higher power. Studies show spirituality helps patients cope with stress, make crucial medical decisions, and improves their quality of life.

In the past, spirituality has not been considered part of nursing therapeutics.  However, with the focus on holistic care and respecting and responding to individual patient needs, nurses are increasingly being asked to identify and fill spiritual requests. At the forefront of the shift are advanced practice Master of Science in Nursing (MSN) nurses who work as leaders to guide healthcare teams.

In filling these spiritual needs, nurses are using screening tests that quickly identify patients who desire counseling. The Rush Protocol, developed by Rush University Medical Center in Chicago, is widely considered the most valid spiritual screening tool.

Nurses also take spiritual histories for a more in-depth look at the patient’s spiritual and religious background to determine the most helpful support.

Dr. Christina Puchalski of the George Washington Institute for Spirituality and Health in Washington, D.C., made the following recommendations for spiritual screenings and histories:

  • Patients should be screened for spiritual needs quickly after entering the healthcare system.
  • Healthcare professionals should be trained to recognize symptoms of spiritual distress.
  • Spiritual screenings should be documented in the patient’s medical file.
  • A chaplain should be called to follow through on spiritual requests.

Responding To Spiritual Requests

Inevitably, nurses face spiritual requests they are not equipped to address. The HealthCare Chaplaincy Network and Spiritual Care Association said nurses who are asked by patients to pray could use the following guidelines:

  • Ask for clarification for the request and communicate respect. For instance, if a patient asks for accompaniment in prayer, the nurse might respond, “Of course. What specifically would you like for me to be praying for?” Then follow up with, “Would you like for me to be praying for you throughout the day, or would you like to say a prayer together now?”
  • If the nurse is uncomfortable with engaging in prayer, tell the patient, “I don’t usually pray with my patients directly, but I can call the chaplain, who does. And I will promise to hold you in my thoughts and heart today and throughout your journey.”
  • Ask the patient to pray first and then echo the sentiments and context of the patient’s prayer.
  • Be sensitive to the patient’s faith traditions and religious background, using care to maintain appropriate boundaries

Experts also suggest nurses utilize some of the basic tenets of the profession: empathy, communication, and professionalism.

About Duquesne University’s online Post-Master’s Certificate program

Nurses who already hold an MSN degree and want to acquire specialized skills are encouraged to pursue online Post-Master’s Certificates.

Duquesne University’s Post-Master’s Certificate programs in Family (Individual Across the Lifespan) Nurse Practitioner, Forensic Nursing or Nurse Education and Faculty Role allows MSN nurses to earn additional credentials and formal certifications from professional organizations.

Post-Master’s Certificate coursework is conducted online, allowing advanced practice registered nurses (APRNs) to continue working while expanding their careers.

  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349217/#B18
  • http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf
  • https://healthcarechaplaincy.org/docs/about/nurses_spiritual_care_white_paper_3_3_2017.pdf
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