By Annette R. Karnash, R.N., M.N.
Though many nurses recognize the need to care for the whole individual, spiritual concerns often remain a neglected area of practice. Spirituality is a belief that relates each individual to the world and gives meaning to our existence. It is everyone’s search for meaning and purpose in life. It is the way in which we forgive and forget, the need to give and receive love, the need for hope and creativity, and the way in which each of us establishes and maintains a relationship with God. Caring for patients spiritually is different because each person has a different frame of reference and in today’s fast paced high-tech health system, the time does not always permit developing deeper human connections, which is necessary for sharing and bonding to assist in fulfilling spiritual needs.
Patients with newly diagnosed or exacerbated chronic illness can experience tremendous life changes and are at risk for spiritual distress because it taxes both their physical and emotional coping abilities. Remember, this is not a temporary but a permanent life long disease. The disease often forces adaptation to life changes, family adjustments, changes with body image and self esteem, loneliness, grief, loss of power and hope, pain, financial concerns, sorrow and depression. They use denial and refuse to acknowledge this is happening to them – “No, I’m not a diabetic, the doctor just said I was borderline, but I’m fine” They become angry and ask “Why me?”, “Why is God punishing me?” “What’s the use of living?” Anger and guilt over life’s disruptions can be experienced. The loss of control or dependence allows for feelings of anger, frustration, sadness and guilty in the chronically ill patient. Unfortunately, we health car professional are sometimes perceived as uncaring and contribute to their feelings of loss if we are unsupportive.
Nurses should be able to interpret an assessment of a patient’s and families’ strengths, weakness, feelings and thoughts and potential problems and these must be verified by interpersonal communication between nurse and patient. How do we intervene? Often simply just by being present, listening and observing, may be all that is necessary. If patients perceive suffering as punishment, they may develop insomnia, anorexia, decreased communication and resign themselves to continual suffering and despair. When people, activities or God are missing in one’s life or they fear they are not being understood, loneliness and isolation can develop and lead to spiritual distress.
It takes time to develop a trusting relationship. It is necessary to validate your understanding of what the patient says by restating what he/she says in your own words. If your time is limited, let it be known that “I have about 10 minutes and I’m here for you now” They may be willing to open up, but not so if they sense your urgency to leave. Share with them a familiar or similar experience as a patient reminisces about their life for this promotes a profound healing effect. Reminiscing allows a person to relive past experiences, representing a time of personal growth and strength, thus reinforcing them to think, “I did it once and I can do it again.”
Though these events can no longer be experienced, it can be comforting and therapeutic. Music and humor are two additional avenues that can relieve tension, sadness and grief for the nurse and the patient. Nurses have accepted the responsibilities associated with high technology, but we should not forget the nurturing, personal aspects of our profession.
