Honoring Religious Practices
When Maria Krol, DNP(c), MSN, RNC-NIC, a professor in Southern Connecticut State University’s nursing program, talks to her students about religious traditions, she gives them this concise advice: “I tell them check ‘I wouldn’t do that!’ at the door.”
Krol’s point echoes what many experts say when thinking of the delicate and critically important intersection of religious beliefs and medical practices. No matter your own beliefs or your own understanding of what will make a patient’s health better, each patient has to be able to live with their choices, says Krol.
And while nurses need to have an understanding of the impact religion can have on a patient’s approach to medical instructions, they do not necessarily have to become experts in world religions to be effective.
“How they interpret practices is in some sense irrelevant to nursing,” says Marsha Fowler, co-author of Religion, Religious Ethics and Nursing, and professor of spirituality and ethics for the Haggard School of Theology at Azusa Pacific University in Azusa, California. Patients, even those within very specific traditions of one faith, can still have varying practices and beliefs. “What they share is how traditions define their health care and influence their choices,” says Fowler. “Interpretation of one’s own traditions is widely divergent.”
If you are unsure of a patient’s preferences and wishes, just ask, says Fowler. “At the heart of nursing is relationships,” she says. “At the heart of religion is relationships.”
“In this day and age, it is not politically correct to talk about religious beliefs,” says Barbara Head, president of the Hospice and Palliative Nurses Association, and assistant professor in the interdisciplinary program for palliative care and chronic illness at the University of Louisville School of Medicine. “But as a nurse, you have to ask about those beliefs.” And realize that even those who don’t align with a particular faith may still hold significant beliefs. “Think of spirituality before you drill down to religion,” she says. “Everyone is spiritual. There are very spiritual people who don’t go to church.”
A 2004 study published in the Annals of Family Medicine showed that 83% of respondents were open to discussing their religious beliefs and spirituality with medical staff at least in some circumstances. Patients reported wanting physicians to understand their beliefs and use that knowledge to help guide their approach and interactions. Some said they thought if caregivers understood their religious beliefs, they would gain a better understanding of the patient and how he or she makes decisions.
Most experts say nurses should have a general understanding of the major faiths of the population they treat, but should not be as concerned with understanding the practices as they are with understanding how the patient interprets those practices. “You need to know how religion functions and how religious traditions define health, care for the self, and care for the stranger,” says Fowler. “It is how their religious faith informs the ways they do or do not care for themselves during times of illness.”
And in many cases, nurses may find that most religions set aside many guidelines and regulations in instances of illness, says Fowler. In Judaism, she says, 610 of 613 religious laws can be set aside in case of illness—only idolatry, murder, and adultery cannot. But patients may want to adhere to certain traditions because those practices give them comfort. “If a patient has eaten a particular way all his or her life, the need to adhere to it may not be a matter of religious faith but a not wanting to change the diet when ill,” she says.
Nickie Burney, NP, a recent graduate of the Simmons School of Nursing and a nurse practitioner on the inpatient general medicine ward at Brigham and Women’s Faulkner Hospital in Boston, says sometimes patients are looking for reassurance before they open up to you. “Patients want to talk about themselves and how they treat a problem, and how their families react,” she says. “If you don’t give them space to understand their practices, you are shutting them down. Let them tell you that.”
One of the best ways to help patients who rely on faith and spiritual practices is to ensure a continuity of care throughout all the nursing staff and shifts. Nancy Beck, a nurse in a progressive care unit at a Columbia, Missouri, hospital, says reporting details from nurse to nurse keeps information from getting lost. If you can do this in front of the patients and the family, the result is that much better. “It relieves a lot of stress on the family when it is shared openly,” says Beck.
Of course, be mindful of any information that could cause discomfort. For instance, some faiths strongly believe in same-sex caregivers. Muslim patients who may need time to pray five times a day will appreciate it if procedures are not scheduled during those times. Some religious holidays require fasting, sometimes for hours at a time.
“Communication is the key,” says Krol. “You can’t assume they know something is important.” A diabetic cannot go a whole day without food, so Krol says finding a modification of the practice that will work and be acceptable to the patient is crucial. You can give all the instructions you want, she says, but if the plan is something that the patient is not willing to live with, follow-through will be poor.
Advice for New Nurses
Even if a nursing school offers a general overview course in world religions, the nuances of religious practice and belief are something you can only get by interacting with each patient. Hopefully, a nursing student learns a little amid the science-packed nursing curriculum, says Head. But it really takes time with patients and the guidance of a mentor for a nurse to gain comfortable footing on such an often-intangible subject.
Head’s advice for new nurses is also helpful for any nurse who wants to feel more comfortable dealing with religious topics. “Encourage people to talk, ask open-ended questions, and be a good listener,” she advises. Questions like “How does your spirituality impact your coping?,” “How important is spirituality and religion to you?,” and “What do you rely on in times of need?” can help you understand your patient’s needs.
Burney also advises listening carefully to other clues that may be faith-based. Discussions about foods or medicines they have used might give you more insight to their practices if you just ask about them. “I just tell them I have never heard of that and ask them what is that and what does that do,” she says. “You have to ask people what is going on.”
Finding Your Own Comfort Level
Nurses know their jobs bring them in contact with people in crisis who may be asking themselves and their caretakers tough questions. Patients might even ask you to pray with them or might inquire about your own religious beliefs. How comfortable are you with that?
“Nurses help people and tend to think they have to fix a problem and do something,” says Head. “There is no fix for spiritual questions.” And even when patients ask difficult questions like “What will happen after I die?,” Head says they are not looking for an answer. “They are asking to be heard. Even if you give an answer, it might not work for them.”
Nurses don’t have to solve everyone’s problems, and for issues they find uncomfortable or unable to answer appropriately, they should always remember to call on the leaders of the patient’s faith, whether that is a chaplain, rabbi, shaman, or whomever the patient prefers.
Sometimes, especially if a nurse is going through a personal crisis, spiritual discussions with patients can be uncomfortable. While many experiences in a nurse’s life can help others and be meaningful to them, assumptions about religion have to be set aside. That can be challenging for a nurse, but it is important for the patient.
“If a nurse is uncomfortable with that, he or she probably needs to do a little work in that area,” says Head. “There needs to be a self-awareness that there is that discomfort. They can read books or speak with a counselor or spiritual mentor.”
If you are comfortable with other religions and participating in some way, you can say to the patient, “You pray and I will pray with you,” advises Head. You can ask them for their words of prayer if you want. Some nurses prefer not to pray in another faith. That is fine, says Head, just let the patients know that while you respect and honor their beliefs, you are not comfortable participating but that you will call the chaplain for them.
“It is about taking a deep breath and being centered and confident in who I am,” says Beck. “My recommendation is to get clear on your beliefs and to know what is your truth.” Nurses certainly don’t come to this realization without some reflection and some thought, but if they can take the time to do so, they will end up in a much more comfortable place. Beck says she knows when most patients ask her about her beliefs, it comes from a place of caring.
A nurse’s responsibility is to make sure patients have enough information to make an informed choice about their own health care. “Once they are given that information, then we support their choice, even if it may not be our choice,” says Head. Especially in palliative care, choices about treatment are very personal. If the choices stir up feelings in the nurse, it risks shifting the focus of the conversation from the patient to the nurse. “Without even realizing it, I can walk into a room with an agenda,” says Burney, who is cautious about evaluating her own assumptions.
Carol M. Davis, DPT, EdD, MS, FAPTA, a professor emeritus in the University of Miami Miller School of Medicine’s department of physical therapy, recommends the FICA method of evaluating how to get a sense of what is happening with your patient.
The FICA evaluation method, developed by Christina Puchalski, MD, allows a nurse to assess how religion and spirituality play a role in a patient’s understanding and motivation to get better and what he or she relies on for support and comfort. The evaluation includes questions about the patient’s: Faith (Do you consider yourself religious?); Importance and influence of religion (How important is religion to you?); Community (Besides attending church, are you a member of other groups?); and Address in care (What can be done to help you get your religious and spiritual needs resolved here?).
Studies have shown that patients are comfortable with discussing religion with caregivers who are willing to walk the line of spirituality and science. “The bottom line,” says Davis, “is that active listening and compassion is enough, along with questions of ‘how can I help’ and ‘who can I get to come talk with you?’”
Despite the often-charged atmosphere around religion and diverse beliefs, nurses’ questions are often received with relief and welcome. “Human beings all want the same love and respect for the individuals we are and want to be listened to,” says Davis. “The ill have resources to cope, and for most people that will include some spiritual help. Our job is to help.”
Julia Quinn-Szcesuil is a freelance writer based in Bolton, Massachusetts.
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