New Zealand palliative care nurses experiences of providing spiritual care to patients with life-limiting illness

Abstract

There are challenges in identifying and defining spiritual distress and there is complexity in the provision of spiritual care. However, for the nurses in this study, focusing on the individual patient and developing a relationship that enabled the patient's unique spiritual needs to be met was highly valued. Creating a culture where nurses, and other health professionals involved in the patient's care, share their experiences of spiritual care provision and discussion about how this can be documented is needed.

Spiritual care provision to end‐of‐life patients: A systematic literature review

“…Spirituality is considered to be integrated within all nursing care, influencing and infiltrating all aspects of an individual's biopsychosocial-spiritual being thus increasing the difficulty in its assessment (Bailey et al, 2009;Carroll, 2001;Keall et al, 2014;Walker & Waterworth, 2017). Physical pain, for example, was viewed as potentially having physical, spiritual and psychological components:…”

“…His pain relief kept escalating without any effect. We sat down and talked… and got him to tell his story… and his needs for opiates actually decreased significantly (Keall et al, 2014, p.3201) There was diversity in nurses' personally unique understanding of spirituality (Bailey et al, 2009;Belcher & Griffiths, 2005;Carroll, 2001;Kale, 2011;Pittroff, 2013;Walker & Waterworth, 2017;Wittenberg, Ragan, & Ferrell, 2017). This included concepts of transcendence, purpose, meaning and values, and related to, but different from religion (Bailey et al, 2009;Carroll, 2001;Kale, 2011); interconnectedness with ourselves, others and God/universe (Carroll, 2001;Kale, 2011); the inner self/essence (Carroll, 2001); and conversely equated with religion in Uganda (Kale, 2011): "I guess it's [spirituality] that there's something greater than me, a power or life force" ( Bailey et al, 2009, p.43), "My spirituality is the meaning I would give to my life," (p.43) and…”

“…Participants believed this integrated ethos to be developed and shaped first by personal understanding and practice of spirituality (Bailey et al, 2009;Belcher & Griffiths, 2005;Carroll, 2001;Kale, 2011;Minton et al, 2018;Pittroff, 2013;Walker & Waterworth, 2017;Wittenberg et al, 2017). One nurse frequently prayed for wisdom and discernment prior to meeting patients: "So to really ask questions, trying to pull out what's important to them" (Minton et al, 2018, p.178…”

“…Participants identified the necessity of establishing a connection and/or rapport (Bailey et al, 2009;Carroll, 2001;Harrington, 2006;Keall et al, 2014;Minton et al, 2018;Pittroff, 2013 (Keall et al, 2014, p.3199) Phrases used to describe this process include "journeying with," "being with" or "standing alongside." Nurses come alongside to relate and support rather than focused on performing tasks (Bailey et al, 2009;Carroll, 2001;Harrington, 2006;Keall et al, 2014;Minton et al, 2018;Pittroff, 2013;Walker & Waterworth, 2017). "So there is only so much I can do.…”

“…Key attributes nurses believed to enable spiritual caregiving include nonjudgementalism (Carroll, 2001;Harrington, 2006;Keall et al, 2014;Minton et al, 2018;Pittroff, 2013), empathy and acceptance (Belcher & Griffiths, 2005;Carroll, 2001;Harrington, 2006;Pittroff, 2013), respect (Belcher & Griffiths, 2005;Carroll, 2001;Walker & Waterworth, 2017) and compassion (Carroll, 2001;Keall et al, 2014;Walker & Waterworth, 2017). None of the studies mentioned the need for or suggest strategies for patients with a different spiritual viewpoint from themselves although some studies mentioned nurse discomfort with patient or family beliefs or practices that differed from their own (Belcher & Griffiths, 2005;Carroll, 2001;Kale, 2011;Keall et al, 2014;Walker & Waterworth, 2017). In one U.S. study (Belcher & Griffiths, 2005) where 71% of respondents held regular religious practices, nurses reported experiencing discomfort or distress when attempting to care for and comfort patients who held distressing religious/spiritual views, such as not being forgiven by God, or who had no religious affiliation.…”