A hospital chaplain was invited to deliver a paper about creating, in a hospital setting, a culture where spiritual care is embraced. She confessed to a colleague that she was not sure how to begin. He responded, “Just tell the audience what you do here at the hospital—and you’ll be doing it!” Somehow that seemed too simple; however, it turned out to be the best place to start. If nurses and other health care providers are not convinced from their hearts that there is an extensive role for spirituality in a healthcare setting, and act that way, they will not go out of their way to provide spiritual care. Even health care providers who agree about the importance of spirituality sometimes find that it is hard to act because they feel shy or timid about raising “personal” issues such as faith. The Dalai Lama, whose faith and compassion precede his physical presence, has repeatedly said, “Real care of the sick does not begin with costly procedures, but with the simple gifts of affection, love, and concern” (Dalai Lama 2006, i). The purpose of this paper is to describe how acts of affection, love, and concern by nurses and other health care providers are foundational to the provision of spiritual care.

When individuals seek health care, whatever the setting, they bring spiritual issues along with their health issues. Spiritual issues are the things that cause patients to “squinch” between their eyes. Health care providers know what “squinch” is. It is the wrinkle between the eyes that gets really deep. It is the pain of the soul, the cry of the heart that no pain medicine can cover. The “squinch” calls nurses to sit with patients, hold their hands, and spend time with them. But other demands, such as physical care and documentation, tug their hearts in other directions. Nurses at the bedside caring for patients with spiritual needs understand the importance of treating patients as holistic beings (O’Brien 2008; Schmidt and Mauk 2004; Shelley and Miller 2006; Umbreit and Umbreit 2002). Soul pain cannot be alleviated with a morphine drip, and a breaking heart cannot be mended without loving care. Healthcare providers can demonstrate affection, love, and concern through authentic expressions involving touch, prayer, and presence.

Touch

A hospital volunteer once described her tears as she was being prepared for brain surgery. The surgeon, who was about to explain the first step of the procedure, paused to dry her tears with his handkerchief. She revealed, “Then I knew I would be alright, whatever happened. He cared about me.” Similarly, when a cardiologist explained to a patient and her husband the possible outcomes after a heart catheterization, he put his hand on hers as he calmly explained open-heart surgery. The patient reported, “This touch made the difference that Xanax could not.”

Nurses must be open to their perceptions, the perceptions of their patients, and “the between.” “The between” is experienced when one turns to another offering authentic presence and allowing the authentic presence of the other (Buber 1958). In the previous example, the authentic selves of the surgeon and the patient created healing in “the between.” The touch was both physical and metaphysical. The surgeon’s wiping of her tears provided physical contact and his authentic presence touched her heart. This was an act of reciprocity whereby each saw the other as a person rather than as an object.

Prayer

When visiting a colleague who was hospitalized, a respected surgeon shared a copy of a talk that he gave at his Temple about the Mi Shebe’rach prayer that he prays each morning. This is a prayer for healing, a prayer for the renewal of body and the renewal of spirit. In his version, before the prayer for others, he prays for health care providers to have the strength and courage to make their lives a blessing. One of the authors has stood at the bedside of a patient when this surgeon was about to operate. He prayed this prayer and indeed became a blessing and an instrument of healing.

A woman, waiting outside the intensive care unit where her daughter lay, eagerly approached a chaplain whom she had met sixteen years ago when a family member died. She told the chaplain about her daughter who had been without speech and movement for four weeks. The daughter had improved to the point of being able to be positioned in a reclining chair. The woman, with silent tears running down her face, told the chaplain that, “I knew I could go home without fear and leave my daughter in the ICU because a nurse stayed in the room while I prayed with my daughter.” This act demonstrated affection, love, and concern. The nurse stayed while the mother prayed, joining in the “Amen” with her whole being. When she finished, the mother asked if the nurse was a woman of faith. The nurse replied, “Yes and I pray for my patients every night when I leave here.” The woman told the chaplain, “I knew everyone gave her good care, but now I know that they really care about her.” The simple act of joining in prayer was an authentic sharing of self and created an environment where spiritual healing occurred.

In the same way, when one of the authors was hospitalized, a health care provider who was performing a diagnostic test said, “You’re always praying with us. Is anyone praying with you?” Then, the health care provider offered a beautiful prayer, asking for God’s blessings for health and healing, right down to the last corpuscle. After she prayed, she revealed that she often does not pray aloud for people. She worries that it might disturb patients or cause them worry. Instead, she prays silently for patients during testing. She shared that, “God still blesses them.”

When the authentic expression of prayer occurs, individuals are consciously invoking God’s presence to “the between.” Prayer, which is as unique as the individual who prays, can be an expression of gratitude for abundant blessings or intercessions for those in need (O’Brien 2008). “The words are not important, only the feeling in the heart” (Umbreit and Umbreit 2002, 41). Prayer involves reciprocity because it requires listening to God’s response. Many patients and health care providers have experienced prayer as an unexplainable source of power and healing (Mauk, Russell, and Schmidt 2004).

Presence

Health care providers are eager to touch patient’s hearts. Because they do care and do want to share in healing, they pursue careers in health care. Many pray for the courage to make their lives a blessing to those in need, to fulfill the Biblical mandate to feed the hungry, visit the sick, comfort the dying, to clothe the naked, and to free the captive. Presence is greater than therapeutic communication because it is not restricted to the notion of sending and receiving messages in verbal and nonverbal forms. Presence has been described as listening with a loving heart (O’Brien 2008).

In many health care organizations, it is standard practice to let patients and families know the names of team members who will be providing their care. Nurses often tell patients about various interdisciplinary team members, extolling the contributions that each will make. However, when nurses are uncomfortable discussing spiritual care, they may be less able to articulate the role of the chaplain. It may not be unusual to hear something like, “We also, if you feel like it, if you don’t mind, and don’t take offense, she’s really a nice person, we have a chaplain, if that’s ok with you, but if you don’t want her to call she won’t.” It does not come as a surprise that patients respond to this type of introduction by saying, “No thank you.” In contrast, nurses who really “get it” about the care of the heart are comfortable discussing spirituality. Nurses such as these are likely to say, “The chaplain is going to be calling, and you’ll have a great conversation with her.” It is hard to understand that nurses can be comfortable asking about eroding breast disease or swollen scrotums, but cannot bring themselves to ask about the source of strength for coping with their patients’ illnesses.

Health care professionals can help patients identify spiritual issues and label their feelings. Patients or family members can benefit when care providers probe with statements such as, “It sounds like this is a really deep issue for you. It seems to be a part of your spiritual life or a religious concern for you. Can I listen or find someone who can help you?” Health care providers offer spiritual care when they intervene by asking, “Would you like me to read that prayer card you’re clutching? Are you sad that it’s Passover and you’re not home to clean and eat Seder with your family? Are you disappointed that it’s Easter and you’re not able to go to Mass? How are you coping with the realization that you’re never going to be able to make Haj?”

Even if a cry of the heart is not recognized as spiritual distress, responses to questions such as, “Where do you find strength to deal with this?” will reveal spiritual issues. If health care providers find that they feel uncomfortable and cannot answer questions about spiritual issues, it is appropriate to acknowledge patients’ concerns and find someone who can intervene. It is not realistic to expect that all health care providers will be experts at providing spiritual care. A team approach is essential because there are more than enough needs, more hurting people than can be consoled, and more brokenness than can be repaired. Fortunately, there is hope to heal through a team approach to spiritual care.

Nurses need to help other staff members recognize their own ability to address patients’ spiritual issues through lived dialog. Everyone who encounters patients has a responsibility to take care of their hearts. For example, when a physical therapist is walking the halls with a patient and listens to the expression of loneliness resulting from being estranged from a family member and acknowledges the individual’s pain, that therapist needs to know that he is not just passing time with the patient, but that they are doing spiritual work and walking on Holy Ground. When a security officer takes the arm of a newly widowed elderly woman and walks her to the car, pats her hand, and gives her a hug, he is easing spiritual distress. When a registration clerk translates a prayer into Spanish, spiritual care is provided because the prayer is converted into the language of the heart of the family waiting outside the intensive care unit. When a housekeeper helps ease a woman into a rocking chair so that she can hold her dying baby and a security officer accompanies the chaplain as she carries the baby’s body to the morgue, they are attending to the pain of the soul. All of these actions nurture the broken hearted, console those who weep, and care for the children of God. Nurses need to tell others that this is spiritual work and provide them with resources to support the work that they do. Staff members need to know that sharing the heart is as important to patients and their families as is quality medical care. Remembering that patients seek care for pain and fear keeps the focus on holistic care. It is about caring for people who come to us with diseases and with dis-ease.

Nurses and other health care providers, as people of faith, help to heal others. Although a cure is not always possible, they can always share in the healing. It is a blessing to be entrusted to care for the lives and bodies of others. When care providers embrace their work as a blessing, it makes a difference not only to the individuals whose rooms they enter, but for the institution in which those rooms are located. The cries of the heart will continue wherever nurses, and other health care providers, deliver care. Patients, in their pain and fear, need offers of affection, love, and concern. Healing occurs when a relationship brings authenticity to “the between.” May nurses and other health care professionals have the courage to embrace spiritual care and facilitate a renewal of body and spirit in the lives of those they touch.

Z. Ann Schmidt is Director of Pastoral Care at Stamford Hospital, Stamford, Connecticut.   Nola A. Schmidt is Associate Professor in Valparaiso University College of Nursing. Janet M. Brown is Dean and Professor in Valparaiso University College of Nursing.

WORKS CITED

Buber, Martin. I and Thou. Ronald Gregor Smith, trans. New York: Scribner, 1958.

Dali Lama. “Forward.” In A Time for Listening and Caring: Spirituality and the Care of the Chronically Ill and Dying. Christina M. Puchalski, ed. New York: Oxford University Press, 2006.

Mauk, Kristen L., Cynthia A. Russell, and Nola A. Schmidt. “Planning, Implementing, and Evaluating Spiritual Care.” In Spiritual Care in Nursing Practice. Kristen L. Mauk and Nola A. Schmidt, eds., 243–275. Philadelphia: Lippincott, Williams and Wilkins, 2004.

O’Brien, Mary E. Spirituality in Nursing. Standing on Holy Ground. Sudbury, MA: Jones and Bartlett, 2008.

Schmidt, Nola A. and  Kristen L. Mauk. “Spirituality as a Life Journey.” In Spiritual Care in Nursing Practice. Kristen L. Mauk and Nola A. Schmidt, eds., 1–19. Philadelphia: Lippincott, Williams and Wilkins, 2004.

Shelley, Judith A. and Arlene B. Miller.  Called to Care: A Christian Worldview for Nursing. Downers Grove, IL: Intervarsity, 2006.

Umbreit, Alexa W. and Mark S. Umbreit.  Pathways to Spirituality and Healing: Embracing Life and Each Other in the Face of a Serious Illness. Minneapolis: Fairview, 2002.