Following Jesus in Nursing

Welcome to Following Jesus in Nursing, a podcast for nurses and students produced by InterVarsity's Nurses Christian Fellowship. I'm your host, Lara K. Kiser, and together, we'll be inspired by our guest stories, tackle big questions with experts in the field, and walk together in following Jesus at the intersection of faith and nursing.

Nurses are dealing with human tragedy. So to not recognize and appreciate that component of personhood is to be depriving the person of an important aspect of themselves, never mind a resource and means for coping.

Today, we'll be hearing from Dr. Elizabeth Johnston Taylor, who has done extensive and valuable research, writing and teaching on spiritual care in nursing. Listen in to part 1 of our conversation.

Well, hello, Beth. Thank you so much for joining me today. It's really great to have you on the podcast.

Thank you.

Could you just get us started with an introduction? Tell us a little bit about yourself. Help us get to know you a little bit.

Well, I've been a nurse for about 40 years. It's hard to believe I'm that old, but I've loved every moment of it. I started out on an oncology unit, evening shift in suburban Hinsdale, Illinois. And loved it so much that I decided I wanted to learn more. And I thought I'd become a clinical nurse specialist.

In the process of applying for grad school, my undergraduate mentor said to me, Beth, don't just think about a master's degree. You really need to think about your terminal degree, i.e., a doctorate. So because I'm a very dutiful, obedient girl, someone who wants to please others, I started looking into PhD programs actually way back then and found one that was a combined MS to PhD program, you know, post baccalaureate doctoral program. So I ended up going there, University of Pennsylvania.

But maybe I'm getting ahead of myself. I am a mother and a wife, and a teacher. I'm a professor at Loma Linda University School of Nursing here in Southern California. I teach primarily in our PhD program, so I teach classes like quantitative methods and psychometrics and writing for publication.

Wow.

But I also have an elective course that I love teaching and I think students love taking. It's called spiritual care, nursing theory and practice. And it allows doctoral students to think conceptually and empirically, philosophically, quantitatively about, you know, studying spiritual care. But then also include some pieces about the actual delivery of spiritual care and teaching spiritual care since many of these students might end up doing that. So, yeah, a little bit about me.

Yeah. So I live in Southern California. I live just a few minutes away from the Rose Bowl in Pasadena. Yeah. So I love walking in in this neighborhood. I do that almost every day. Walking for me is not only a way to get exercise, but kind of a way for me to mentally cleanse and to pray. So yeah.

Thanks for sharing all that. And I'm excited to get back to the spiritual care part, since that's what we're here to talk about today. But before we do that, I would love to hear just a little bit of your story of how you became a nurse who follows Jesus.

Lovely. Yes. Well, first of all, maybe I should talk about following Jesus and that story. I'm an MK and a PK, which means my dad, my parents were missionaries in Korea, and my dad was actually a preacher over there, taught theology. So you might say I got Jesus in the breast milk.

I just was always in the environment. So for me, learning about Jesus and following Jesus was just my culture, you might say. It was what I would do given how I was raised. So, you know, gradually through life, I think God presents opportunities for us to define and make our religious walk, our spiritual walk personal. And indeed, that's been the case. So I would say my own spiritual development has been one of kind of a slow gradual evolution rather than some crisis happened, and all of a sudden, I was converted. I used to, I think, as a teen, hear those kinds of stories, and they'd be so inspiring. And I would like, oh, but that's not me. What's wrong with me?

And then I heard a preacher give a sermon about his story being much like mine, and then it kind of, like, gave me permission or perspective that this was just as valid a way of being Christian and coming to be Christian. So, however, having said that, I would say in my adult years, mid-adult and then recently, God has sent me, you might say pivot points that have spurred, enriched, challenged my own spiritual journey, and brought me growth. One of those things was my husband wanting to move to New Zealand. And me being someone who resists change. Yes.

I really do. I'm not an early adopter. You know. Long story I won't go into, but that experience of moving to New Zealand, it ended up being only for 5 years. But that experience was one where I later came to realize I was choosing what a psychologist might call ego destabilization so that I could allow spiritual transformation that does typically come out of that.

And then I would say also just in the last about 5 years, you know, I'd always heard about a dark night of the soul, but never experienced one. For me, it had always been following Jesus made me happy. Inner peace at moments and affirmations and, you know, consolations. But I went through a period a few years ago where the consolation was not there. And I struggled. I searched, and I cried. You know? God, where are you for me now?

Yeah.

And seemingly didn't hear the answer like I thought I was supposed to. So, again, TMI may be here, but just to let you know that my journey with Jesus has been strengthened through that experience. And I would say even my work now as a scholar, I think I appreciate maybe the experience many patients might go through in their own dark nights of the soul because of now having gone through that myself and trying to learn more about that process from spiritual giants.

Yeah. Thank you for sharing that. And do you wanna go into how you got into nursing?

Alright. That was the other half of the the question. It's okay. It's a big question. Yeah. Well, you know what? I grew up thinking I didn't wanna do what normally women in my social strata did. I you know, you're a teacher or you're a nurse or you're a secretary. Nope.

Didn't wanna do that. I wanted something different. But yet I knew I wanted to help people. So I started college with a helping profession, a major that would lead me there, but I it just didn't click. I didn't like it, and then I was undecided.

And then I had a friend who I'd grown up with land in the ICU. And I remember going to visit her and just feeling the excitement of the buzz of this ICU. And that perhaps in combination with some other things just made things click and made me realize, you know, I think maybe I would like to be a nurse. So in my third year of college, I started nursing.

Wow.

Yeah. So, yeah, college took more than 4 years. And I have absolutely no regrets. Loved being at the bedside even though my years there are quite limited.

Like I say, I went on to grad school and then just kinda got sucked into that scholarly life of a nurse. So yeah.

Yeah. And then how how have you seen nursing and following Jesus kind of be integrated?

Yes. Well, I guess developing evidence and synthesizing evidence about this notion of spiritual care and how spiritual responses to illness intersect with that sick role, with health is my way of doing it in a very overt way.

Yeah. So spiritual care integration really has come out of your sort of calling to both following Jesus and to nursing. That's so cool. So tell me more about how this became such a big part of your research and teaching and writing.

Yeah. You know, as I look back on it, I realized there's been kind of an evolution for me. So I'm a Christian that has been socialized by a denomination that is quite evangelistic minded. So and, you know, being the daughter of missionaries and a pastor, you know, I had that in me. And I think in my 20s, when I went into nursing, I had this orientation that, you know, I should be praying with patients.

I should be talking to them about Jesus, kind of overt witness. And yet, I also, I think, was sensitized to the fact that you can't be belligerent and coercive about that. So, you know, I don't think I was ever that way. But I would say initially, my interest in spiritual care evolves from that personal background in combination with the fact I was in an oncology setting where, face it, many of these patients were dealing with their mortality and asking very difficult questions that were existential and spiritual in nature. So I'd say that's how it got started.

And then I can remember one of the research studies I did kind of in my early 40s involved interviewing cancer patients, hospice patients, about how prayer intersected with their illness. And it dawned on me that what really was prompting my research, if I could be so honest, was my own spiritual need. I, too, wanted to know how am I gonna pray when I'm faced with tragedy or with, like, my dissertation and postdoc work? I looked at this phenomenon of searching for meaning. Well, how am I gonna reconstruct meaningfulness in my life, and, you know, spiritually when I'm faced with a serious illness or my life is threatened or, you know, whatever.

So, I think, yeah, I'd like to say now I'm more evolved, and now my scholarship is perhaps a little more authentically about wanting to create a healing, nurturing, loving environment for those who are sick as well as the nurses who are providing care for those who are sick. We all need it. Oh, I was gonna tell you, maybe this is too tangential. But let me tell you about maybe the pivot point that made me go the direction of scholarship in spirituality and health rather than something else.

When I was an undergraduate, I was an honor student. And at my university, they required some type of scholarly project before graduation. So I did one looking at nonprocedural touch of nurses and how that was perceived by elderly persons who had, you know, received nursing care. And so that kind of opened my eyes up to this notion of caring touch, and that excited me. I thought that was cool. So, you know, a few years later when I'm applying to grad school and they're saying, well, what do you want your area of research to be? You know? At 25, what do I know? But I said, oh, I think I'd be interested in looking at nonprocedural touch.

But then I also said, I think I'm also interested in this idea of spiritual care. Because as I said, that comes out of my life story. So here I am at an interview at a secular Ivy League university, and the faculty are asking me, what do I want to pursue? They are given these two options, and their response to me was, oh, oh, and mind you, the touch the one reason I was interested in touch is because one of the professors there was a person who I'd cited in my undergrad research who I thought would make a good mentor. Well, it ends up she was my mentor.

Wow.

However, it wasn't for touch. It was for spiritual care in nursing. Yeah. So during the interview, the faculty response was, oh, we think we can support you to study this exploration of spirituality and health. No mention was ever made about touch as a topic for research. So you know, God used these women to influence my future.

Wow. That's so cool. Well, and you have written a lot, which I will share some links for some of your writing that people can check out in the show notes. So that will be available. Yeah. So let's get into the topic. What is spiritual care, and why is it so important?

So there are different definitions for spiritual care. I would say maybe very simply put, though, we can just say it's the ways of being and doing that a nurse offers to a patient that promotes their spiritual wellness. So perhaps that's just a real simple definition. There is a definition I really like by some Canadian scholars, Rick Sawatzki and Barb Peset up in British Columbia, who talk about spiritual care beginning in a space of love. And then how that might evolve into addressing religious practices or other things that a patient might want that supports their spirit.

For me, I think a helpful metaphor for talking about spiritual care. Actually, maybe there's two metaphors I'll share with you. One is a bar stool that has three legs. And if you would say one leg is like the mind and the other like a body and the third being like the spirit, you know, reflects how philosophers across the centuries and millennia have talked about personhood: mind, body, spirit. Right?

So if you've got a seat supported by these three things and you remove any one of them, you collapse. So if you remove the spirit and, you know, the person collapses. So for me, that's a helpful way of underscoring the importance of attending to one's spirituality. And, of course, when one experiences tragedy, maybe your life is threatened, maybe you've lost a limb, maybe a beloved one has, you know, left you or, you know, whatever it is. Nurses often often are dealing with human tragedy.

And so to not recognize and appreciate and perhaps address, if appropriate, that component of personhood is to be depriving the person of an important aspect of themselves, never mind a resource and means for coping. Another metaphor that I really like is using the light bulb analogy. If you think about the light bulb being our body, you know, the glass, the aluminum, the tungsten, whatever it is that makes a light bulb, that's analogous to the body. And then a light bulb emits warmth and light, which you could equate with emotions or the psychological aspect. So what is it, however, that energizes that light bulb and allows the light and the warmth to be emitted?

It's the electricity. And so, you know, for me, the making the spirit analogous to that electricity or the electrons is helpful. It's attending to that spirit, which vitiates and, provides meaning and purpose for one's life you know, pivotal. Why would you not recognize it and address it when that is welcomed.

Yeah. I love that analogy. That's great. So as a patient, I don't know that I ever would have guessed that spiritual care was sort of part of a nurse's role, and that's nothing against the wonderful nurses that I've had in my own health care over the years. But I'm just curious, how do you feel like this part of the nurse's role of caring for a patient has gotten maybe a little sidelined or, you know, seems like there's some obstacles that come up when engaging in spiritual care for patients.

It's interesting that you use the word sidelined to talk about spiritual care in nursing. I'm not exactly sure that it has become sidelined. I think if we look historically throughout the millennia, those who have provided what we would call nursing care have often done so from a space of religious promptings. Not that that may have expressed itself overtly in introducing religious practices to those who are sick, but it must have inevitably been somehow, involved, I would think. So I think what's happening now in modern times and in modern nursing in regards to spiritual care is something that has evolved and reflects social movement, you might say, social forces.

So, spirituality historically has been nurtured in the space of institutionalized religion. And now in Western societies, anyway, that's less and less. I think the latest statistics are roughly a third of Americans see themselves as either nones or dones, done with religion or none, no religion. So given, there's still, however, an awareness of and desire for spiritual nurture and and growth in humans. I mean, inherently, we are designed that way.

So if we're not getting that support, that nurture, that comfort, that prompting for growth in religious context, then we're gonna be looking for it in other context. So I think that maybe what is helping to fuel nurses to say, hey. This can be part of what we do. Not only, you know, the evidence showing how indeed the illness and health challenges can evoke more spiritual awareness and desire for spiritual nurture and growth. So, you know, nurses wanna be there for that and to support that. But social forces, I think, are really bringing this to the fore. It's not maybe that it was sidelined before. Yeah. That makes sense. Well, I hear kind of a mixed bag around spiritual care. So I've heard that it's part of the code of ethics and requirements for Medicare funding. On the other hand, I hear a lot of nurses who are fearful in many contexts about praying with patients, maybe not in a sort of Christian health care or hospital space. But, in general, it seems like there's some fear around, you know, their jobs are on the line if they go too far in talking about spiritual or religious things. So, yeah, I think that really surprised me not being a nurse, you know, hearing that spiritual care was such an important part of it and the code of ethics and Medicare funding requirements, and then also seeing nurses be very afraid to provide it, because they don't wanna cross a line. I was wondering if you could just speak into that tension a little bit. What are you seeing there?

Yeah. And, indeed, I think, there are actually many barriers to nurses providing spiritual care, probably. And there's a number of studies that document this. Probably the most commonly cited barrier is just time and a perception that there isn't enough time.

But, maybe we can talk about that another time, because I'd like to think spiritual care isn't something that is done during necessarily it can be, but isn't necessarily done in a separate period of time. It can occur concurrently with, you know, dressing changes and whatever. Anyway, yeah. And nurses do tend to focus on the physical and making sure the patient is still breathing. And, you know, so spiritual care is optional for those with that mindset.

And some might wonder whether it's truly within the role of nurses. And then many will say they just feel inadequately trained. Yeah. It's very uncomfortable for them to do, so they don't do it. But to your point here now, many, I think, avoid spiritual care because they fear proselytizing and the potential for unethical coercion, which I must say I would be very grateful for a nurse to be cautious in that regard.

I don't think Jesus' love was ever coercive. And as Christian nurses, of course, we wouldn't wanna be that way. So your comments though about these various, professional and societal impetuses, if that's a word, for providing spiritual care, I think it's important for us to look a little more closely at them. So when you say nursing codes, when you look carefully at the way these codes are written, these codes are not the same. Every nurse must be providing spiritual care to every patient.

That isn't the language of these codes. These codes say things like the International Council of Nurses, ICN code. It uses this language. Nursing care is respectful of multiple things from sexual orientation to religious or spiritual beliefs. So I think there's a big difference between a nurse showing respect and a nurse feeling like they have to talk about a dying patient's beliefs regarding an afterlife.

You know? There's a big difference there. So if you say spiritual care is about respecting one's spiritual or religious beliefs, then yes. In terms of Medicare funding, my understanding, now, I haven't read all these codes and policies. But my understanding is that for Medicare to provide support for a hospice, then they do have to make sure that spiritual care is part of the team and is involved.

I'm not sure this is true in other contexts, however. So, it isn't like there's this broad dictate that spiritual care, the way some might define it, is supposed to be happening for every patient by every health care provider. That I think, creating perhaps a thinking that is possibly conducive to some unethical spiritual care. And if it's unethical, I'm not sure it's spiritual. But, anyway, unethical care.

So I'll tell you in terms of, just, maybe a simple way to think about this. The patient and the nurse, they are in a power differential. Right? The patient is in a very vulnerable position, and they don't wanna do anything to offend us because it might compromise the care they receive. So, I think it's really important for nurses when it especially in this context of spiritual care to remember that there is this asymmetric relationship and to not exploit it.

So, I have a couple of colleagues who wrote a lovely piece, an ethicist and a nurse scholar here at Loma Linda, Jerry and Betty Winslow, who did a lovely piece where they provided just some very simple guidelines for helping us to determine maybe whether or not the spiritual care we're gonna give is ethical or not. And what they would say first is we've gotta assess. Right? That's the beginning of the nursing process. We've got to assess what that patient's preferences are and what their needs are, what their desires are with regards to spiritual care.

Because if we haven't assessed that, then we're not gonna know how to ethically respond. So once we do have that assessment, then we want to follow their expressed wishes and not prescribe our own or pressure them to relinquish theirs. And in order to prevent me from coercing them, I've gotta actually know what mine are. And so I can keep those in check. Right?

So the power dynamic you were naming, that makes sense to me. But then I also hear nurses say that patients can be very difficult. I guess I'll say to put it lightly, I heard some horror stories. Some patients don't seem to care whether nurses like them or not or whether they're pleasing the nurse.

Yeah. But I could see how that would be a power dynamic, like, you wouldn't obviously wanna hold. Someone shared a story of, like, a patient could be afraid that you won't give them their medication if you don't pray or something like that.

I mean, a worst case scenario story there. Yeah. Horrible.

I could understand that too. So what do you see.

Yeah. Thanks. I love hearing you think about this. It expands my own thinking.

So, you know, when I hear about a difficult patient or a patient who you think must be in a power differential with the patient having more power than the nurse. Yeah. Here's my take on that kind of patient. I would say the bully. you know? I mean, it's just like what we teach our kids. Bullies are actually very afraid. They're coming from a space of fear. And when it manifests in the patient context, the way I think chaplains talk about it is there's a regression going on. So a person's best self, when confronted with, Hey. I might die. I might lose my loved one. I might have diabetes the rest of my life, or whatever the threat is. It's a threat. And when humans are faced with threats, they can respond in anger. They can also regress towards more childish behavior.

I mean, that's human. That's human. And so when a nurse encounters that I mean, okay. Maybe this patient just spit at them because they told them they had COVID or whatever. If a nurse can remember that that patient's behavior and seeming power is actually coming from a space of fear. That bullying is because they're regressing. Then you start seeing how you might call it, the love power differential is really great. And this is the person who all the more needs a nurse who can respond in love, which maybe is, you know, back to Kevin Sawatsky's definition of spiritual care. I mean, ultimately, take all the layers, all the spiritual care things or practices, the interventions, it's about being. So truly being able to be present to them in a space that is sacred and loving. And I would argue that that can push the needle for them towards that space as well and that's spiritual care.

Wow. Yeah. That's so interesting. I never would have thought about it that way when someone is kind of in their worst situation and fear and hurting that they would almost be like a child. You're kind of taking care of a child and children don't always respond in the most others-thinking ways when they're hurting and scared.

So helpful to think about.

We'll take a pause here in my conversation with Beth and pick it up in the next episode. In the meantime, I would be absolutely delighted to hear from you about your own experiences of navigating spiritual care in your nursing practice. Do you have a story to share, advice based on your own learning, or maybe questions about how to practice spiritual care better? Message me on Instagram at Jesus nurse pod or email me at ncf@intervarsity.org using the subject line podcast. .

Thanks for joining us for another inspiring episode of Following Jesus in Nursing. We hope you've been encouraged and equipped in integrating your faith with your nursing practice. Be sure to check out our show notes for info about connecting with Nurses Christian Fellowship as well as links and resources mentioned in today's episode. Don't forget to check out NCF membership at ncf-jcn.org and use the coupon code Following for $10 off. And remember, as you go about your work as a nurse, you are not alone.

Jesus is right there with you, guiding your steps and using you to bring healing to those in need. Thanks for listening to Following Jesus in Nursing, and may your faith continue to be a light in the world of health care.