Background
One of my patients—I’ll call her Mrs. Jones—has severe hypertension. Apparently, it runs in her family, as she tells me that her mother had “high pressure,” as do two of her siblings. She worries that her children may have inherited the condition, but knows that if that turns out to be true it is not her fault. In all of the cases within the family, the hypertension has come on in late middle age.
Spiritual Assessment
The Jones family is quite religious. I base this judgment on my observations of the family and from the conversations I’ve had with Mrs. Jones. The entire family, including Mrs. Jones, her daughter, son-in-law, and three children, attend church every Sunday and often attend services during the week on Wednesday evenings. After church on Sunday, two of Mrs. Jones’ other children—a son and a second daughter—bring their families to the Jones home for Sunday dinner. The family is careful to say grace before their meal and the conversation during dinner is often about the day’s sermon and Bible lesson. Even the youngest children are expected to participate. The family speaks of the head minister of their church with great reverence and seems to take all of his pronouncements very seriously. I believe that the church is not affiliated with any mainline denomination, and is evangelical Christian in its outlook.
My own spirituality
My own religious beliefs differ from those of Mrs. Jones, yet I can respect her views and believe that she and her family members are good people. I am not a close adherent of a particular church, although I do believe that the universe has meaning. To be honest, I am still working out my own beliefs. In general, I feel that I am very tolerant of the religious beliefs of others as long as those beliefs don’t infringe on the rights of other people.
Caring for Mrs. Jones and other patients in the future
I feel that Mrs. Jones’ spiritual needs are fully met by her church and her family. When she makes a remark containing a religious opinion, I usually just smile and say nothing. I certainly would not contradict or argue with her.
In her textbook, Spirituality in Nursing, Barnham (2010) makes some interesting points about the levels of spirituality as conceived by Fowler (1981) and Peck (1993). She writes that at the stage where Mrs. Jones seems to be—Stage Three for Fowler and Stage Two for Peck—people are quite literal in their beliefs, and strongly adhere to a single view as taught by a formal institution, usually a religion. In this stage people “take comfort in relying on a power outside of themselves” (19). My own stage of spirituality seems to be more in line with Fowler’s Stage Four and Peck’s Stage Three, which are marked by a person’s “struggle with conventional systems” such as formal religions (20).
According to Barnham, there are other theorists, such as Bloom (1994), who see spiritual development not as levels, but as styles. I like this terminology much better than the word “levels” because the latter implies the superiority of one style over another. In my mind, each person’s approach is of equal value and all are deserving of respect.
It is this basic outlook that forms my view for how I will handle spirituality in caring for my patients. If I don’t agree with a patient’s religious views, I will simply keep quiet about it. If a patient makes a comment or asks a question that requires some type of response from me, I will avoid confrontation and try to do as I am doing with Mrs. Jones—just smile and say nothing. To cite Farnham one last time, “Perhaps the most common question from patients is some form of ‘Why did God do this to me?’ The nurse may best understand that a response of touch or of simply being there is adequate” (23),
References
Barnham, B.S. (2010). Spirituality in nursing: The challenges of complexity (3rd ed.). New York: Springer.
