BARRY WILLIAMS / Special

In her palliative care class at Kennesaw State University, Dr. Lois Robley teaches students about the importance of using spirituality to assess patients and help them cope.

A patient dies and the only family member arrives too late to say goodbye.

A neonatal intensive care team whisks a baby away from the delivery room, leaving the mother and father alone to grapple with the implications of their son's problems.

An elderly woman keeps a vigil by her comatose husband day after day, with few people acknowledging her presence.

A woman learns that her brain tumor is inoperable.

Each scenario presents an opportunity for a nurse to bridge the subject of spirituality to either the patient or the family member.

The Joint Commission on Healthcare Accreditiation requires that a chaplain or minister be available in the hospital for consults.

But nurses, by their very nature, can incorporate spirituality into patient care.

Whether working on the oncology floor, the orthopedic floor or visiting a home, each encounter with a patient offers an opportunity to explore a patient's spirituality.

There's a distinction between spirituality, faith and religion, said Sharon Stanton, MS, BSN, RN, director of the Center for Health Ministries at Saint Joseph's Hospital in Atlanta.

"Faith has to do with our values, beliefs, morals and ethics," Stanton said. "On the other hand, religion is the structure - it's how we show our faith. Spirituality is a way for patients (or any person) to relate to their God or a higher power."

All too often the focus is on the physical well-being of the patient and on the symptoms, said Stanton.

"Remember that patients are in crisis when they come into an acute-care setting," she said. "They need to be understood from a physical, emotional, intellectual and spiritual perspective. But physical seems to get all of the attention.

"We need to look at the person as a whole."

Ron Fortin, RN, said using spirituality helps him do his job in the ICU.

"When caring for patients day after day in the ICU, too often we see them as an extension of the equipment," he said.

In his job working with critically ill patients, Fortin sees a chance to help family members with their religious needs, too.

"It keeps me in balance," he said. "I look at the patient as a person with a spirit, rather than someone who may be comatose."

In Fortin's Baha'i faith, treating the spirit is as important as the body and mind. But, he's quick to caution that his personal beliefs remain his and he looks for those beliefs that will help the patient or family with whom he's working.

Kennesaw State University nursing professor Lois Robley, Ph.D, RN, conducts a palliative care class in which nurses learn to assess a patient by adding spiritual questions to a routine physical evaluation. In Robley's class, students might be trained to ask about a religious affiliation or what gives a patient the strength to cope with illness.

She uses a spiritual interview provided by the ELNEC core curriculum. Spirit is the word used to create a template for nurses to think about as they go about their care: S - spiritual belief system; P - personal spirituality; I - integration with a spiritual community; R - ritualized practices and restrictions; I - implications for medical care; and T - terminal events planning.

Robley emphasized that spirituality is used a tool, not as a proselytizing vehicle.

"It's never appropriate for nurses to preach or teach their own faith to another," she said. "It is, however, appropriate to listen respectfully and encourage discussion of a patient's beliefs.

"Spirituality can be a powerful adjunct to other modes of healing."

Spirituality in the art of healing is an often-overlooked influence in a patient's outcome.

"Spirituality has become a very hot topic among community members," said Rabbi Scott Saulson, Ph.D., community chaplain for Jewish Family Services.

If the nurse takes the time to ask a patient about their dietary needs, or observance of the Sabbath, "it can make a difference in how a patient reacts to their medical situation," Saulson said.

When people miss a religious holiday, they may feel guilty or depressed - feelings that can affect the healing process, Saulson said.

Hospitals usually are willing to accommodate a person's religious affiliation, but they need to know it's important to the patient or the family. Experts agree that spirituality doesn't have to mean nurses praying with their ill patients, but that they can if the need arises.

The ability of medical professionals to approach the topic of spirituality may help patients respond to their physical and mental status.

"A precondition to wellness is that these things [body, mind and faith] need to work in tandem," Saulson said.

Anita Price, RN, director of Pediatric Services for Interim HealthCare in Atlanta, is a strong advocate of spirituality in health care. It's a rare day that she doesn't help another nurse, parent or child work through a medical crisis using spirituality.

Price believes in exploring her patients' beliefs.

"It might be something as simple as finding out if their religious requirements are taken care of," Price said.

Price says she often is asked by other nurses, "Why do you always get to the topic of religion?"

Her answer is simple. "It's important."

Spiritual support to the patient "may be just a hand on the shoulder, a hug or a prayer," Price said. "Faith is what our belief, trust, hope and values are based on."

Patients sometimes ask Price if she thinks they are going to die. She answers by saying, "If you have thoughts about dying, then there may be things you want to do to get ready."

Then her patients (and their family members) can begin to feel more comfortable about topics they haven't been able to discuss before. If there are specific spiritual requirements that haven't been met, she helps them find a way - their way.

It might mean calling a minister, reciting the Lord's Prayer with a patient or playing a certain piece of music that brings them a new level of comfort, she said.

"It's talking from my heart, not just talking," said Price. "I want patients to feel comfortable with where they are."