S2E7: Barriers to Spiritual Care

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

Spiritual care isn't really about fixing. It's not about making things right. It's about being spirit to spirit, present with the patient in the moment.

Well, welcome back, Kathy. Here we are for our final episode for the season. Can you believe it?

Well, yes and no, but I'm excited. Yeah. It's exciting to wrap this up and bring it home.

Yes. We have covered a lot this season on our theme of spiritual care from preparation and integration all the way to following the Holy Spirit's leading and offering assessment and intervention. So today, we thought we could wrap up the season with just addressing some barriers that come up in giving spiritual care. A lot of times in Nurses Christian Fellowship, we get questions from nursing students or nurses about what is and isn't permitted around spiritual care. So they might, for example, come to us with a question about their manager has said or insinuated that they can't pray with a patient or they can't talk about spiritual things with patients.

So they might get in trouble for spiritual care. How would you respond to that, Kathy?

Well, those are great questions and I have heard them as well. I guess the first thing is I would wonder, like what's really going on here? What's the whole story? Because we know that spiritual care is a part of whole person holistic nursing care. We know that people are body, mind, spirit. We know that spiritual assessment and spiritual care is required by the Joint Commission for Accreditation of Hospitals and Healthcare Organizations. We know that. We know that there are official nursing diagnoses for spiritual well-being and religiosity. In fact, there's three nursing diagnoses that are official, research out there on spiritual well-being and there's two for religiosity. So it isn't like we're making this up or adding something.

This is documented nursing literature and research. We know that there's specific nursing interventions that are about spiritual growth facilitation and spiritual support. And we know that there's official nursing outcomes related to spiritual health. And what I mean by official is that spirituality, spiritual care, spiritual components are part of what we're taught in nursing education. These are well founded in nursing literature and they are spirituality as a part of current nursing research.

You can find all of these concepts of intervention assessment outcomes in the most up to date books on nursing diagnoses, nursing interventions, nursing outcomes, as well as all general nursing textbooks on just all of nursing. And the last thing I guess I'd like to point out is that researchers have found that spiritual interventions are associated with improved psychological patient outcomes, improved spiritual patient outcomes, improved patient satisfaction. So if a nurse or student thinks they cannot give spiritual care because they've been told we can't do that, or I feel like there's something going on in that situation that needs to be explored. We're not responding to patient needs if we're not giving spiritual care because people are in the hospital, in any care setting, in a physician's office, in a health clinic, they are going to have spiritual issues and spiritual concerns and we need to respond to that.

Yeah, that makes a lot of sense. It sounds like you're saying there's a lot of excellent foundation and reasons. We have a lot going for us basically in the foundation of spiritual care being a very overwhelming positive thing. We know that. You said we need to find out more about what's going on in that situation. We have that background, that information that spiritual care is positive, then how do we find out more about what's happening in the situation? How do we explore where the manager might be coming from or dialogue with them?

In our Frequently Asked Questions in Spiritual Care column in the Journal of Christian Nursing, spiritual care expert and spiritual care researcher Elizabeth Johnson Taylor suggested some options that you can pursue. And I really like what Beth has said. She says first, respectfully, like figure out what's going on with whoever told you you should not give spiritual care; to the manager, or maybe it's another nurse that you're working with. Oh, we can't do that. So ask if you can meet with the manager, set up a meeting in a low key setting, probably their office could be helpful or maybe go to the coffee shop or something.

And you might need to do this before or after work, but set up a meeting and figure out what's going on. And I want you to keep in mind, our goal is to listen carefully. We're not there to defend ourselves or give them a lot of information. We want to listen and figure out what it is that's going on in the situation. What's really happening here?

And maybe you could just start with asking your manager, I want to understand what you're asking me to do about spiritual care. I can you tell me more? Can you tell me more about what you'd like me to do or what the policy is? Or maybe you could say, I'm sensing that you're feeling there's something unprofessional about spiritual care or about the way I might be doing it. Can you tell me more about what you're thinking or what's going on here?

And then just listen. Listen for cues. Don't be defensive. Don't try to argue. Just listen carefully and attentively.

So does the manager maybe believe that spiritual care always leads to proselytizing, always leads to religious discussion? We know that's not true, but do they believe that? Does the manager think that spiritual care, even if it's ethical, is outside the purview of nursing, that we should get a chaplain involved? Has the manager previously had a bad experience with a nurse providing spiritual care? Do they think spiritual care is always proselytizing?

It's always Christians trying to evangelize and get converts. What do they think spiritual care is? So you're going to listen for how the manager is defining spirituality and religiosity. Have they had a bad history of spiritual things? Did something happen in the organization or on the unit that would lead the manager to say, we don't want you praying with patients or whatever it is you've been told.

You're listening for how they're going to define spirituality and religiosity. Is that in line with what you're actually doing? Is that in line with what it should be, what the literature says? So you're listening well and you're trying to understand where your manager is coming from. So then if you feel like they have a knowledge deficit, ask, could I do some research and bring back some literature?

Can I find some things on best practices and spiritual caregiving? So you could bring back information on what it says in the Joint Commission or what the nursing diagnosis handbook, the nursing outcomes, nursing interventions, bring back some information. Again, you're not saying I know and you don't, but you're just saying, can I bring some literature and we can talk more about this? If they misunderstand what spiritual care is, if they don't understand or believe that it's part of the nursing role, provide information that's maybe a gap. And you could also say, here's what I was taught and why I'm doing this.

This is where I'm coming from. And you can back that up then with the literature. If the manager is receptive, maybe ask, could we talk about this in a larger space? Like a nurse a staff meeting, a nursing practice council? Is there a way maybe we could talk about this together?

Like some of the other colleagues in the area are telling me they have concerns about this. Can we talk about this? If you work at a Joint Commission-accredited healthcare organization, and most of us do, and you feel that you can't discuss spiritual care, you feel unsafe talking about this with your manager, you can actually contact the Joint Commission confidentially to report your concern. And there's no fear of retaliation. They have an online reporting system.

It's just jointcommission.org/contactus. But you can actually contact the Joint Commission if you have a concern about how you're being criticized or how you're being told you can't give spiritual care. The first step is listen well, try to figure out what's going on, meet with your manager, meet with others, get some solid literature information and talk about it. And if that doesn't resolve it, or if you feel like you really can't talk about it, then you can go straight to the Joint Commission. They have a query online form.

I actually went and checked it to see, and it's not that hard to do, and you can do it anonymously. So there are ways that you can explore what's going on all the way from let's get more information, let's talk to the manager, let's bring this out in the open respectfully, hopefully, or going to the Joint Commission and saying, Hey, we have a problem here. I don't know what to do. Can you help?

Yeah. That's great. That feels really empowering to hear because we're not stuck. We don't just have to throw up our hands and be like, Well, was told I can't. What you're describing, there's plenty of resources and reactions that we can take with kindness and gentleness but also with courage.

I loved what you said about listening carefully to the manager and trying to collaborate and work with them. I think it's really cool to think about turning this barrier into potentially opportunity to have a larger conversation with the rest of the staff about what spiritual care is and how to implement it well throughout the whole hospital or floor or department that you have influence over. So this is a great first step to take. Are there any other steps that we can take if we're still told that we can't give spiritual care?

One I should have mentioned earlier is pray. Ask God for help and guidance and wisdom and empowerment. Pray. Go to the Lord. Ask him to intervene with you, for you on your behalf.

Ask him to help you understand what's going on in this situation. I think another important step is do an honest assessment of yourself. Elizabeth Johnston Taylor talks about searching your soul. If your spiritual care always brings up your personal faith, are you meeting your needs or the patient's needs? Whose needs am I meeting?

Do I feel a compulsion that I need to convert others, that I need to be right to affirm my religion? Am I uncomfortable with religious diversity or other ways that people experience God that are different from me? I think for Christians, especially those of us who think a lot about saving faith, can I trust God to do the saving, even in a way that might be different from my experience? And I encourage you to listen to episode four of this season on Holy Spirit-led care, where we kind of delved into that a little bit more. So search your soul, you know, what's motivating me here and how I'm doing this?

Am I meeting the patient's need or is there a need that I have that may not be helpful? A second thing is , are you following the patient's lead? Like if you sense a patient is distressed and you say, Hey, I'm sensing you're struggling right now. Is there something I can help you with? Or asking them, What do you do when you feel this way?

Or, What helps you when you feel this way? Let the patient steer the conversation. And they may bring up, Well, I talk to my pastor, I call my best friend. Find out a way that you can assess what the patient needs from you right now. So you're following the patient's lead. And if the patient says, I would call my pastor and ask him to pray with me or her to pray with me, then you could say, Would you like me to pray with you?

I mean, there's things you can do in following the patient's lead. And I think it's really important for us to realize that we're not trying to fix things. I think as believers, knowing that Jesus comes, that the Holy Spirit comes and fixes something is very different from us trying to fix it. It's a different mindset and a different shift. In nursing, we can fix a lot of things.

We can give patient pain medications. We can educate them about what's going on with their illness, or we can do patient teaching. But spiritual care isn't really about fixing. It's not about making things right. It's about being spirit to spirit present with the patient in the moment, that there's not an answer that's like, this is it.

It's more about being with the person. It's a witness kind of idea rather than a fixing or taking away the pain kind of idea. It's about being with the patient in the moment. And I think that's so critical. So the point of all this in the next step was searching yourself, following the patient, checking yourself.

Am I being ethical? Am I following the patient's lead? And if we're pushing our agenda, then maybe we shouldn't be doing the spiritual care that we're doing. Remember, we said to ask, is there something about what I'm doing that you have concerns about? You're asking your manager that.

If a patient asks you what you believe, you are following best practices to share with them what you believe. If the patient asks and you're getting permission to pray with them or to do whatever overtly spiritual or overtly religious intervention, then you can stand by your spiritual care. You're not trying to bait and switch them like, well, can I ask you a personal question and then say, you know, what do you believe about God? Like, you're not doing inappropriate things like that, doing bait and switch tactics. You're letting them lead and you're finding out what they need and you're being fully present with them in your spirit and listening and responding to them.

I think one last question is, are you covering all your responsibilities, or are you dropping the ball on getting any of your work done? And I'm not saying giving spiritual care means you can't give all of your patient care. Remember, we've talked about incorporating spirituality and spiritual care into all we do. But does it appear like you're talking with patients when maybe other care isn't getting completed? So, I just would remind us that we're incorporating spiritual care into all of our care.

It's not stopping everything else to offer spiritual care, but it's including spiritual care in your practice and all that you do. Maybe those responsibilities are things like, was your job to check the crash cart. Did you get the crash cart checked? It's just, are we getting our work done? And would people think we're not getting our work done because we spent too much time talking to the patients?

Yeah, and that's a hard one to think about, but you're covering your responsibilities, you're following the patient's leads, you're being ethical, you're understanding what the problem is. A final thing, I think, is a step you should take if you're told you can't give spiritual care or you feel like there's a barrier to giving spiritual care is document well what you did with the patient. So you're just putting in your nurse's notes, what did you observe? Patient was really tense or they were crying or they wouldn't talk to you, like what's going on? How did you observe a spiritual need?

What did you ask them? What did they ask you and how did you respond? So if you're documenting what you did in your spiritual care, that's very, very helpful because then it leaves a track and it shows that you were meeting the patient where they were at and you were responding to what they needed.

Thank you. That's really helpful. I think that gives us a good handle on how to deal with external barriers that come up. We feel like there's tension in the space around us for various reasons. So we explore what the options are with our manager.

We do that sort of self examination, make sure we're coming at it from a good place. Maybe we could speak a little bit more to those internal barriers as well. I think some of us are just afraid or insecure around our identity as a Christian if we're in a very secular environment or city. I hear this especially from nursing students. You know, they're young, they're fresh into the nursing world, and they're thinking about so many things.

Maybe it's what do I really have to offer? So could you speak a little bit to some of those fears or insecurities and offer some encouragement around the rights and spiritual authority and responsibility that nurses have?

Well, would like to encourage anyone who listens to this episode to reevaluate or check out the Code of Ethics for Nurses. There's actually a brand new 2025 edition just been released by the American Nurses Association. And the code of ethics for nursing is nurses is what we stand on in our practice. It's a treatise on the ethical foundations of nursing. And you can find and read the code online.

There's 10 provisions with interpretive statements. You can go to codeofethics.ana.org and you can read it for free. I encourage you to buy a copy of it so you have your own paper copy, but anytime you can go and look at the Code of Ethics on the American Nurses Association website. The code has been around since the late 1800s and it addresses the strategic relationships nurses have in our practice and what our responsibilities are. Nurse to patient relationship, the nurse to nurse relationship, the nurse to self, the nurse to the profession, the nurse to others, and then nursing to society and the global community.

So there are these six relationships. It states the nurse's primary commitment is to the recipients of nursing care, whether that's an individual, a family, a group, a community, or a population. So your primary responsibility is to your patient, to the recipient of your care. And the provision goes on and it explains within the context of nursing practice, the nurse prioritizes the recipients of nursing care, placing them over institutions. Every clinical encounter and plan of care reflects the fundamental commitment of nursing to the inherent dignity, worth, unique attributes, and human rights of the patient.

So this is what's written that the recipient of nursing care, your responsibility as a nurse is for the patient over the institution. And I don't want to cause a riot here or say anything unruly, but you can stand on our code of ethics. Legally, that's a place for you to stand as a nurse. And so you're looking at the patient, you're meeting them where they are, you're following their lead, and your responsibility is to that patient. That's in provision two of the code of ethics.

Provision four states that nurses have authority over nursing practice and are responsible and accountable for their practice consistent with your obligations to promote health, prevent illness, and provide optimal care. To me, that's really black and white. You have authority over your nursing practice. Your primary commitment is to the recipient of your nursing care. Provision four goes on to outline how nurses have both the accountability and the responsibility for their practice.

And that adds up to authority for your care. So you have authority in your practice setting. If your patient expresses spiritual concerns, if you see a distress or spiritual need, you have an obligation to further assess, diagnose, and intervene. And that's okay. So we've just gone through provision two and provision four about your authority and your relationship with your patient and yourself and your institution.

Provision five says the nurse has moral duties to self. As you, you are a person of inherent dignity and worth, including an expectation of a safe place to work that fosters flourishing authenticity of self at work and self respect through integrity and professional competence. So this speaks to you have a moral duty to yourself to be fully who you are as an individual. The code refers to this as wholeness of character, W H O L E, wholeness of character. So, I am a believer, if I am a person of faith, I can be fully a person of faith in my work.

I'm practicing ethically. My primary commitment is to the recipient of my care. And that's, again, the code says specifically the nurse prioritize recipients of nursing care, placing them over institutions. So, if your patient has a spiritual need, you have not only the responsibility, the right, and you want to, but you have the authority to meet that need. And to do that in the context of the situation, you can feel safe doing that.

And if you don't, you can explore that. And worst case scenario, you could go to the Joint Commission, or you could go to your state nurses association, or you could get some support. I would hope that you could address these issues in your practice setting. I wanted to mention that we just published an article in the Journal of Christian Nursing called Navigating Strategies for Nurses. And it's about approaching relationships and conflicts at work.

You can find it at journalofchristiannursing.com and it's a fantastic article and it talks about just dealing with interpersonal rubs and conflicts and situations at work and how you build good relationships. And I think it could be really helpful to a nurse who felt like she was being told or he was being told that you can't give spiritual care. So you assess yourself, you figure out what's going on in the situation. And that particular article, navigating those workplace relationships could give you some direction on dealing with tension and conflict.

Thank you. This is so helpful. It's very encouraging that there's so much in support of nurses being able to take the lead on spiritual care and you know with humility of course and ethically appropriately, but there's a lot to stand on here and a lot to have confidence in. I think that's so encouraging. So those of you who are new nurses especially or nursing students I hope you're hearing this and feeling emboldened and encouraged to stand firmly and strongly in the authority that you've been given as nurses.

Well, any closing thoughts from you, Kathy, as we wrap up this episode and this season?

As we wrap up the season, I just want to remind everybody and I want to remind myself, spiritual care is simply caring for the spirit. Caring for the spirit is the most basic and foundational care we can offer as nurses. We're spiritual beings caring for other spiritual beings. So don't overcomplicate it, just be present, be with. Spiritual care is about facilitating these relationships for the patient or the client.

They're vertical relationships with God, horizontal relationships with others, and they're in a relationship with themself. It's assessing them for spiritual needs, love, belonging, hope, forgiveness, looking at suffering and more. It's simply caring for their spirit. And I would encourage you, be fully intentional about spiritual care. Don't ever forget, just keep in mind that you can integrate care of the spirit. You should integrate care of the spirit into all that you do as a nurse. You go on to take the blood pressure and you're observing and you're watching and checking on them. And how are you doing and connecting with them and they sense you caring for them. I would remind us all that the most profound spiritual intervention is the intervention the patient needs. It's not the intervention I think they need, it's the intervention they need.

So they sense and they know that you're with me in my moment of need. You stepped into my pain, you're stepping into my world and into my questions. You're meeting me where I am. That is the most profound spiritual intervention. And never forget spiritual care may not and doesn't always produce the desired outcomes that we want to see.

It may not look like it did what it was supposed to do in the moment, whatever spiritual care is supposed to do. I think if the patient feels like you were with them, that's the outcome. But spiritual care leads to fruit of the spirit. It leads to God being at work. So pursue a relationship with Jesus Christ and the Holy Spirit. Ask God to guide your spiritual care and trust him and be present and be ready in the moment and meet the patient where they're at.

This is all so beautiful. Thank you so much, Kathy, for all of your wisdom and advice and excellent research. This whole season you've provided us with so much to think about and I really appreciate your continuous reminder to stay near to Jesus and to do the things that the patient needs most. And so thank you for making a big topic very simple, but also very profound. Really appreciated everything that you've shared this season.

So we would be blessed if you would just close our season out with a prayer for our listeners.

I'd love to do that. God, thank you. I just am so reminded how you care for us that you demonstrate the best in spiritual care that when we come to you, that you're always there. I'm so thankful God, that we can be in relationship with you. It's not a distant relationship. It's an intimate relationship that you want to speak to us. You want to lead us. You want to be present with us. You want to heal us. You are very spiritually present with us. Oh, God, will you help us as we care for others? Give us wisdom, grace, insight, courage. Give us your presence. I pray lead us Holy Spirit and caring as you want to care for people. And most of all, would you just glorify yourself in all that we do and accomplish what you want through our nursing? And we love you, Jesus. We thank you God so much for allowing us to be in relationship with you. Amen.

Amen. We hope you enjoyed this season taking a deeper dive with us into spiritual care. As always, we would love to hear from you. Please send us your questions and stories, connect with our nurse or student ministries or just say hi. You can find our page on Facebook, email us at ncfintervarsity.org or DM us on Instagram at Jesus nurse pod.

Stay tuned for season three coming in January 2026.

Hey, 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 healthcare.