The case of Caroline Petrie highlights the daily challenges facing nurses and has led to an energetic debate about the place of religion in health care. Is spirituality part of a patient’s make-up?
What role do nurses play in the delivery of spiritual/religious care? Should the NHS as a secular institution ignore spirituality/religion?
This is an opinion on the issues that have emerged from the debate and the dilemma for staff in providing holistic - which includes spiritual - care to patients within a secular institution.
So, should Ms Petrie have been suspended for offering to pray for a patient? In a recent Nursing Times survey on the issue, 91% of respondents said ‘no’.
I cannot agree or disagree as I do not have the full facts of the case at hand. However, I do agree with the investigation by her employing trust into an incident related to religion/spirituality reported by a patient or a patient’s carer. And this would be my opinion no matter what faith the nurse belongs to. I also believe the trust was right to reinstate Ms Petrie, having clarified her responsibilities and duties as a nurse, and I’m extremely pleased she is back doing what she loves most - nursing.
Nurses are in a very difficult situation as was highlighted when so many Nursing Times survey respondents said they would find it difficult to deal with patients’ religious needs. On the one hand, there is an emphasis on patient-centred care - which is holistic and recognises the spirituality of individuals. On the other hand, the health service is fundamentally a secular institution. The secular nature of the NHS does not allow assumptions that a patient needs spiritual care or belongs to a particular faith. Nor does it allow an employee to force their spirituality on others.
In many religious countries or religious hospices, the approach will be different as it is understood that the institution is spiritually and religiously based and a primary approach through religion will be seen as a core element of the care. More importantly individuals in such setting are clearly aware of the ethos of the organisation.
Based on the secular nature of the NHS, the NMC code of conduct states that ‘one must demonstrate a personal and professional commitment to equality and diversity’. We live in a multifaith, multicultural society where people hold diverse views, and this must be respected when delivering care in a secular institution. It is what I regard as the essence of person-centred care, and what Lord Darzi has emphasised in the NHS Next Stage Review.
Therefore, it is a nurse’s - and indeed a hospital chaplain’s - professional duty to avoid assumptions that patients want people to pray with or for them. To ask someone whether they want to be prayed for is to assume that person is definitely spiritual/religious and accepts prayer as a means of intervention.
I believe all nurses should be passionate about their patients’ spiritual/religious needs. It is integral to holistic and compassionate care. But that passion should not be dictated by personal spirituality. It should be driven by the patient’s spirituality.
So how should nurses deal with spirituality? Should they ignore religion?
Ms Petrie’s case should not deter nurses from asking patients about their spiritual or religious care needs. Spirituality is fundamental to many individuals and experience shows this comes to the fore in times of illness, crisis and bereavement. In Nursing Times’ survey, 72% of respondents said nursing practice should automatically include a spiritual element. I agree. To acknowledge, respect and even nurture spirituality is part of nursing care.
‘Nurses need to develop an ability to identify individuals who have spiritual needs and recognise their personal boundaries in spiritual care’
However, the survey also showed that nurses believe there is an immense gap in training in relation to spiritual care, and the majority feel there is insufficient guidance for nurses.
The NHS is a secular institution that is staffed by many spiritual people caring for the needs of many other spiritual beings.Therefore, training is essential to address the tension between secular and spiritual.
Chaplains and chaplaincy departments are ideally placed to become an invaluable resource for trusts. They are equipped and trained to deal with spiritual issues, and can support and teach nursing and medical staff around the complex issues that often surround religion and spirituality.
Nurses need to develop an ability to identify individuals who have religious or spiritual needs but also need to recognise their personal boundaries in spiritual care. They need to know when to make a referral to the chaplaincy team and should be guided as to how they might discern the patient’s spiritual needs, using appropriate language and questioning techniques, without making assumptions.
Imam Yunus Dudhwala is the multifaith manager at Newham University Hospital NHS Trust