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You Gotta Have Faith

Largely absent in today's medical environment, spirituality is making a comeback in health care, reconnecting nurses with their patients–and the roots of the profession

By Donna Hemmila
September 3, 2002

Nursing Spectrum
Nurse Wire

Whether they call it faith, inspiration or just the human touch, nurses are finding it more difficult to stay connected to the spiritual roots of the profession. The growing shortage of RNs in hospitals leaves those who remain by the bedside little time to dispense the kind of patient care and comfort that inspired many to become nurse healers in the first place.

Lack of time and a model of medical care that separates spirituality from science are forces nurses say are pulling them away from their traditional healing mission.

Even though most hospitals have chaplain services for their patients, no one expects a nurse to provide that kind of emotional and spiritual support, said Roberta Bube, RN, PHN, a parish nurse who is about to return to hospital nursing part time at the Marion Medical Center in Santa Maria, Calif.

"You have to address mind, body and spirit," Bube said. "I always found time to do it [in a hospital]. I did have to be cautious. I'd have to do it quietly. Everybody's beliefs are different."

A startling 89 percent of RNs who responded to a survey sponsored by NurseWeek and the American Organization of Nurse Executives said the nursing shortage affects the amount of time they have to spend with patients. Another 68 percent of the 4,108 respondents said they've seen the number of patients assigned to each nurse grow in the last year, according to the survey released in April.

Despite this workplace time crunch, nurses need to find time to nurture the spiritual needs of their patients, said Jan Ingram, RN, clinical coordinator of the parish nurse program at Saint Francis Medical Center in Santa Barbara, Calif. "Whether you're giving them a sponge bath or putting them on the commode, if you're really there with them-mindfully present-that is a spiritual action," Ingram said.

"It's not like you have to be there for 20 minutes and put down your clipboard and talk about Christ."

Some nurses say time isn't the only issue. Kay McVay, RN, president of the California Nurses Association, said she isn't a religious person, but like many nurses she views her profession as a higher calling. Today's highly technical health care environment downplays that aspect of nursing, she said, and that is one of the developments that is driving nurses away from the profession.

McVay is not the only one drawing a connection between job dissatisfaction and the withering spiritual roots of nursing, either.

Human connection

"There need to be some changes in the health care system to provide time to address these spiritual issues of patients and spiritual issues of nurses themselves," said Harold Koenig, MD, MH.Sc., RN, an associate professor of medicine and psychiatry at Duke University Medical Center who studies the connection between spirituality and health.

Most people have some religious or broader spiritual foundation in their lives, he said, and when they are undergoing medical treatment, health care professionals shouldn't ignore that dimension of their care.

Koenig, who founded Duke's Center for the Study of Religion, Spirituality and Health, said hundreds of research studies have documented a connection between patients' spiritual beliefs and positive outcomes. Through his own research, he said he has found that patients who pray have better outcomes. From a physician's standpoint, he said, recognizing a patient's beliefs increases trust.

"I've seen patients melt in my office when I've offered to pray with them," he said.

Drawing a line between a patient's spiritual needs and medical needs doesn't make sense, even in secular institutions, he said. Koenig has written an article for the Journal of the American Medical Association that calls for physicians to incorporate a spiritual inventory into each patient's care. All physicians and nurses should do this regardless of whether they work in a faith-affiliated hospital, he said.

At the least, a caregiver needs to know how someone's religious beliefs might affect end-of-life and emergency procedures.

Koenig recognizes that spiritual nurturing can add >> an extra responsibility to a nurse's already hectic work pace. In the interest of quality care, hospitals need to make time for it, he said.

"In the long run, good care is the cheapest medical care you can give," Koenig said.

Even in religious-affiliated hospitals where spirituality is encouraged, the rapid pace of modern health care can overtake spiritual caregiving. But building the spiritual connections between nurse and patient doesn't always take much extra time, said Sister Molly Nicholson, vice president of ministry and spirituality at St. Rose Dominican Hospital in Henderson, Nev.

Nicholson, who has a master's in pastoral care and psychology, encourages nurses to make those human connections with patients. Sometimes it's just a little thing, she said, such as asking patients if there's anything else she can do for them as she leaves the room.

"We believe in the healing of the body, mind and soul," Nicholson said. "That's part of the training for all our staff."

Following tradition


Hospitals such as St. Rose are continuing a long tradition of marrying faith and healing. Some of the earliest nurses came from religious societies such as the Dominican order that founded St. Rose.
Historically, healing and religion grew out of the same faith-based traditions. From the Middle Ages, the old, sick and dying looked to religious practitioners for comfort. When nuns opened hospitals, those institutions became the training ground for nurses. With the development of modern science, medicine and religion took separate paths. Gradually, nursing preparation moved into university settings, and government agencies assumed responsibility for licensing and oversight.

But many hospitals and health care systems in the United States owe their existence to orders of religious women.

St. Rose began in 1942 as a federally operated medical center for workers from the Las Vegas-area magnesium mines. Dominican sisters from Michigan took over the hospital in 1947, turning it into a Catholic nonprofit institution. Nuns became the administrators and the nurses.

In the last 55 years, the center has grown to two campuses, the 138-bed Rose de Lima campus and a 3-year-old, 142-bed Siena campus. In 1988, the Adrian Dominican congregation that founded St. Rose joined Catholic Healthcare West, which runs medical centers in California, Nevada and Arizona.

As in most U.S. Catholic hospitals, nuns in crisp, white nursing habits no longer fill the corridors and operating rooms. Today, St. Rose has seven nuns on staff, but none are RNs. Sisterhood, like the nursing profession, faces a growing shortage of new members. Yet the Nevada hospital anchors its health care philosophies to the spiritual foundation built by the Dominican sisters.

Nicholson holds training sessions for the nurses and other staff members to address workplace spirituality and how it comes across to patients and their families. Everyone is spiritual, if not religious, Nicholson said, and at St. Rose, that concept applies to both patients and employees.

"Nurses are very altruistic," Nicholson said. "They're there to administer to others. I try to point out to them how they can minister to themselves."

Parish nursing

St. Rose, like a growing number of hospitals, offers RNs another outlet for their spiritual cravings through a parish nurse program.

The Health Ministries Association, the professional association for parish nurses, estimates that 6,000 to 10,000 RNs are trained in parish nursing in the United States. Interest in this alternative to traditional nursing is booming, said Lois Peacock, RN, an association member who ran parish nurse training courses in the San Francisco Bay Area for 10 years.

Parish nurses, who function either as paid part-time RNs or as volunteers, provide congregations with services such as health screenings, education and prevention programs, home visits to the sick and elderly and community resource referrals. They make home visits when someone is discharged from a hospital. They explain physicians' orders and after-care-and they follow up with return visits, sometimes spending years working with the same patients.

Those connected with the parish nurse movement say this is the kind of work that first drew them to the nursing profession.

Candy Montalvo, RN, became a parish nurse at Christ the King Lutheran Church in Fremont, Calif., as a way to combine her faith and nursing skills.

"In a hospital or clinic setting, we don't have the time to do that, or the management frowns on it," Montalvo said. "You don't feel comfortable doing it."

Montalvo worked in hospital and clinic settings before turning to parish nursing. "I definitely do not miss hospital work at all," she said. "It's too busy. It's too technical. I didn't have enough time to spend with patients. When I make a home visit, I'm there for an hour. There's no time in the hospital where I could have sat down with one person for an hour."

Most of the parish nurses are taking up this mission later in their careers. They've worked in hospitals and clinics and want another dimension to their daily work. But what about young nurses just starting careers and those who want to work in secular settings?

According to Madeline Wake, Ph.D., RN, FAAN, dean at Marquette University College of Nursing, students learn of the role spiritual beliefs play in healing.

As a Jesuit university, Marquette doesn't have to hide its spiritual connection, Wake said, yet not all nursing students will work in faith-affiliated hospitals when they graduate. "We teach our students to take their cues from client needs," Wake said. "If a health care institution does not respect patient needs, that's not good health care.

The program places students for clinical training in 80 hospitals in the Milwaukee area, Wake said, and there's never been a problem with the nonreligious hospitals.

A nurse has a responsibility to recognize human spirituality, said Dorel Harms, MHA, RN, vice president for professional services at the California Healthcare Association, the statewide hospital group. Nurses are so busy, she said, and any time spent on nonscientific activity has to take a backseat. But nurses still can be effective from a spiritual standpoint.

"Nursing is an art with a scientific foundation. It's based on trust," Harms said.

"Just like in life, you have to be balanced. You can't base everything on science."

Spiritual Movement

  When parish nurse Carol Cachelin, MPH, RN, saw an elderly man shuffling into church one Sunday morning, she immediately recognized that his condition was dramatically deteriorating.
  The man, in his 70s, suffered from dementia and was on kidney dialysis. His gait looked so unsteady, he was at risk of falling. Cachelin first alerted the man's wife that he needed support in walking. Then she found the couple help through a home hospice agency.
  That's the kind of interaction with patients that she didn't have in a hospital setting, said Cachelin, one of about a dozen parish nurses in Santa Barbara, Calif. "In a hospital, you're lucky if you can remember the names of your patients and get the procedures right," she said.
  Many experienced nurses like Cachelin are leaving hospitals and clinics and putting their nursing skills to use in church-based, community health care. Through training courses at nursing programs throughout the country, these RNs learn how to serve the spiritual needs of people as well as their health needs. RNs who turn to parish nursing usually have strong spiritual lives themselves.
  "A lot of people who aren't bent that way wouldn't care to do it," said Cachelin, who often prays with the people she assists.
  Nurses suffer burnout working too many hours with too little autonomy, and they are turning to parish nursing for more fulfilling work, said Alvyne Rethemeyer, MSN, RN, director of the Deaconess Parish Nurse Ministries in St. Louis.
  The parish nursing movement traces its roots to Lutheran minister Granger Westberg who, in the 1980s, reignited an interest in coupling healing with religion, with a focus on treating the whole person. His work evolved into the Parish Nurse Resource Center. That organization, at the time based at the Lutheran General Health Care System in Park Ridge, Ill., offered the first standardized course for parish nurse training. The Advocate Health Care System purchased the Lutheran system in 1995 and added International to the resource center's name and mission. Today, the International Parish Nurse Resource Center is housed with the Deaconess Parish Nurse Ministries and continues the annual Westberg Symposium.
  While many parish nurses come from a Christian background, the movement attracts all faiths, and nurses don't necessarily work in a church or synagogue where they worship. Educators suggest churches have a health committee to oversee the nurse's mission.
  Lisa Pemberton is part of such a health ministry team at Eden United Church of Christ (Congregational) in Hayward, Calif. The church members wanted to enhance their work in the community and are creating a parish nurse program.
  They're looking for a part-time nurse to work with church members as well as the church's teen program, after-school center and a community family shelter that the congregation helps to support.
  While churches are looking to parish nurses to enhance their community work, hospitals are doing the same.
  Alta Bates Summit Medical Center in Berkeley, Calif., recently has expanded its parish nurse program with a grant from the Susan G. Komen Breast Cancer Foundation. The hospital, which had three parish nurses serving 25 congregations, added a nurse bilingual in English and Spanish to serve the Hispanic population, with an emphasis on breast cancer awareness.
  The hospital uses the parish nurse program as a way to satisfy its state-mandated community service requirements, said Shyrl Hayman, coordinator of the hospital's health ministry/parish nurse program. Many people are more willing to take part in health screenings and education programs at their church than to come to the hospital, she said. The parish nurses give the hospital another avenue for reaching the community.
  "For whatever reason, there is a movement now to have a relationship with the community and faith-based organizations," Hayman said. "It's not just the hospitals."
  Rosemarie Matheus, MSN, director of the Parish Nurse Preparation Institute at Marquette University College of Nursing, is a pioneer in developing training curriculum. She sees parish nursing as a way to fill a void in the health care system with its emphasis on preventative care and community outreach.
  "Hospitals that are visionary will take this on," Matheus said.

~Donna Hemmila
Copyright 2002. Nursing Spectrum Nurse Wire (www.nursingspectrum.com).
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