The case of a community nurse suspended at the end of last year for offering to pray for a patient has sparked fresh debate on the relationship between health care and religion. Helen Mooney finds out what nurses think about the issue
At the end of last year North Somerset PCT decided to suspend one of its nurses, Caroline Petrie, for offering to pray for a patient. Ms Petrie was later reinstated to her post but the case unsurprisingly attracted widespread coverage when it came to media attention earlier this month.
Last week Nursing Times carried out a survey to gauge the views of the profession on issues surrounding the case, which attracted more than 2,500 replies in only three days – nursingtimes.net also has received more comments and views on this particular story than any other.
The survey results show that the overwhelming majority of nurses think that the PCT went too far, with 91% saying that Ms Petrie should not have been suspended for offering to pray for a patient.
One respondent described it as a ‘ridiculous overreaction’ while another said ‘nurses are accused of far worse and do not get suspended’.
‘I don’t know all the facts but as long as she wasn’t trying to instil her beliefs onto the patient I can’t see any harm,’ was one reply, which perhaps characterised best many of the comments.
However, there were those who backed the trust’s move. One respondent said: ‘If the patient initiates the request then there is no problem but until that happens there should be a clear division between personal belief and work. If the nurse is unable to abide by that then the only alternative should be suspension.’
Ms Petrie, a community nurse and a Baptist from Weston-super-Mare, offered to pray for a 79-year-old patient on a home visit. The patient reported the incident to another healthcare worker, saying she had been ‘taken aback’ but not offended.
Ms Petrie has said in the press that praying is her way of saying ‘get well soon’ and even said that she would do it again.
She was accused by her PCT of breaching the NMC code of conduct by using her professional status to ‘promote causes that are not related to health’ and by failing to ‘demonstrate a personal and professional commitment to equality and diversity’.
According to the trust, it was ‘not acceptable’ within the NMC’s code of conduct ‘to project personal beliefs unless invited to do so by patients and families’.
A PCT spokesperson told Nursing Times that although the organisation would not say it was wrong to pray for patients, the issue was ‘more complex’.
The trust said it understood that for ‘some people of faith, prayer is seen as an integral part of health care and the healing process’ and that it was ‘acceptable to offer spiritual support as part of care when the patient asks for it’. But it warned that ‘for nurses, whose principal role is giving nursing care, the initiative lies with the patient and not with the nurse’.
The PCT, as stated, made much mention of the NMC in its reasons for the suspension. However, the council has not commented on the individual case and whether the PCT was correct in its interpretation of the code of conduct, which does not offer specific guidance on religion or prayer in the NHS. An NMC spokesperson told Nursing Times that the council did not feel it needed to be more specific on religion or spirituality. ‘It is up to nurses to interpret the code of conduct – it does not need to be more explicit, if they need more guidance or advice on the issue they should come to us, we can give that advice on an individual basis,’ she said.
Likewise an RCN spokesperson said the college currently had no guidance that dealt specifically with the issue of faith, although religion will feature in part under new guidance on equality, along with race and gender, later in the year, she said.
With the possible exception of that which may be given out by individual trusts, seemingly the only guidance available on religion at the moment is the Department of Health’s new policy document Religion or belief: A practical guide for the NHS, which was published last month.
It devotes an entire section to warning NHS staff against ‘proselytising’ – or preaching and trying to convert people to a religion. But this seems an odd fit with the case of Ms Petrie.
‘Members of some religions, including Mormons, Jehovah’s Witnesses, evangelical Christians and Muslims, are expected to preach and try to convert other people,’ the guidance states.
‘To avoid misunderstandings and complaints on this issue, it should be made clear to everyone from the first day of training or employment, and regularly restated, that such behaviour, notwithstanding religious beliefs, could be construed as harassment under the disciplinary and grievance procedures,’ it adds.
However, it does not state anywhere that a nurse or any other healthcare professional cannot offer to pray for a patient.
The Nursing Times survey clearly shows that there remains a great deal of confusion within the profession surrounding religion in the workplace, and specifically this issue of praying for patients (see box).
Should nursing practice automatically include a spiritual element?
‘Spiritual support is an integral part of holistic practice’
‘You do not have to be religious to be a caring individual’
‘It should be included in our initial assessment. If the patient has no need or desire for spiritual help it does not have to be an ongoing consideration, although nurses should remember that even the most unbelieving often look for God at times of great stress and crisis’
‘Spirituality is distinct from faith or religion and can be anything from a photograph album to a sunset, a Beethoven sonata – or indeed a hymn of praise to a Creator. We are all spiritual beings’
‘The role of the nurse is to support those patients in doing what they cannot do for themselves, and we should be mindful of their own spiritual needs rather than our own while at work’
Of those who responded to the survey, 85% felt there was insufficient guidance for nurses on praying for patients. More than 40% said they had been asked by a patient to pray with them and an overwhelming 91% said it could be appropriate for a nurse to pray with or for a patient.
Additionally, three-quarters thought that there was not enough advice on dealing with religion at work in general and a further 75% said that nursing was not adequately prepared to deal with the religious needs of different cultures.
All of which suggests that the DH and others need to try harder in making it clear to health professionals what they can and cannot do regarding religion and the NHS workplace.
The government, however, told Nursing Times that it thought its guidance was sufficient and disagreed that it had failed to debate widely enough in its development.
Is there sufficient guidance for nurses on dealing with religion at work in general?
‘No one wants to talk about religion and only God knows why’
‘In my work place we received information on all religions except Christianity. A sign of our times?’
‘Religion and belief guidelines are still to vague, superficial and open to diverse interpretation’
‘More information on different faiths in education would be helpful. As would being able to discuss the topic without fear of suspension’
‘The NMC Code of Conduct talks about not using your professional status to promote interests outside of nursing but this is a very broad statement and open to many interpretations, and misinterpretations’
A DH spokesperson said its new guidance aimed to ‘raise awareness of the key issues that may face patients and staff from the diverse range of religions and beliefs that are now common within the UK’.
‘It encourages consultation and assessment of the needs of those served. Prior to its publication the guide was widely consulted on with patients, staff and interest groups,’ the spokesperson added.
But those who stand on the bridge between religion and health care disagree. According to Anne Aldridge, president of the College of Healthcare Chaplains and a hospital chaplain at Addenbrookes hospital in Cambridge, there needs to be clearer guidance, which includes information on where nurses can go for help and training.
Ms Aldridge was critical of the ‘lack of uniformity’ in religion and spiritual training for nurses across the NHS. ‘The help and training nurses are getting on this is different across the UK. I am not against nurses praying with patients but patients can be very vulnerable, so nurses have to be careful. There is a very fine line,’ she said.
Ms Aldridge said that at the hospital where she worked, the chaplains ran an education and introduction programme when nursing staff had their induction.
‘We explain about the spiritual needs of the patients and how praying is very much often a part of that. We talk to nurses about how they can get involved in spiritual care and if they feel anything is beyond their expertise while working how they can call on the help of a hospital chaplain as part of the NHS team,’ she said.
Has a patient ever asked you to pray for them?
‘Some patients are hopeless and they need hope. And as a believer we know prayer brings hope’
‘Provided the patient gives uncoerced consent, what’s wrong with prayer? As far as I know the basic rule is do no harm. I do not think prayer harms anyone’
‘I do it all the time, however I do not offer it directly. Providing the initiative comes from the patient, personally I can’t see the reason why I should refuse’
‘We offer paracetamol, one could offer prayer – the patient always has the right to say no. The patient can always say no, what’s wrong with an offer?’
Steven Fouch, general secretary of the Christian Nurses and Midwives Association, agreed. Perhaps unsurprisingly he said he felt that in the case of Ms Petrie the PCT had overreacted. But he added: ‘The NHS does not have very good guidelines on spirituality and care.’
He described the new DH guidelines as ‘vague’. There needed to be ‘much more of a debate about how people are trained to give appropriate spiritual care’ and the DH did not consult widely enough before issuing its guidance, he said.
‘There needs to be a dialogue between all the vested parties including the DH, the professional bodies, NHS Employers, all the faith communities and even the British Humanist Association,’ he added.
For now, it definitely appears that there is a need for greater clarity on the role of nurses in dealing with issues of religion and spirituality.
As one survey respondent said: ‘Nurses need to be supported and criteria laid down to avoid unnecessary emotional and political angst.’
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