If I could give you information
of my life, it would be to show
how a woman of very ordinary
ability has been led by God
in strange and unaccustomed
paths to do in His service what
He has done in her.
Florence Nightingale, 1860
By Lyn S. Murphy and Mark S. Walker
Spirit-Guided Care: Christian Nursing for
the Whole Person
3.0 ANCC
contact hours
144 JCN/Volume 30, Number 3 journalofchristiannursing.com
Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited.
journalofchristiannursing.com JCN/July-September 2013 145
ABSTRACT: Healthcare today is challenged to provide care
that goes beyond the medical model of meeting physical needs.
Despite a strong historical foundation in spiritual whole person
care, nurses struggle with holistic caring. We propose that for the
Christian nurse, holistic nursing can be described as Spirit-guided
care—removing oneself as the motivating force and allowing
Christ, in the form of the Holy Spirit, to flow through and
guide the nurse in care of patients and families.
KEY WORDS: Christian worldview, holistic care, medical
model, nursing, spiritual care
pressing physical needs while integrating spirituality into her care? How can
she care for the whole person?
MEDICAL MODEL CARE
The Institute of Medicine (IOM,
2001; IOM, 2010) reports the U.S.
healthcare delivery system is challenged
to provide consistent, high-quality care
to all people. In their sentential report,
Crossing the Quality Chasm, the IOM
(2001) outlined strong evidence that
the healthcare system frequently harms
patients and routinely fails to deliver its
potential benefits. Researchers have
cited various contributing factors such
as rapid medical science and technology advancements, growing complexity
of care, and changing patient needs.
Healthcare organizations are challenged
to work more efficiently and effectively
while reducing costs and maintaining
high standards of quality and safe care.
Nurses, who are at the forefront of
healthcare, are charged with offering
safe, patient-centered care and practicing to the full extent of their education
and training (IOM, 2010).
Much of today’s healthcare continues to be based on a “medical model”
TIRED NURSING?
Maya tiredly
walked to the
Surgical ICU
for her third 12-
hour night shift
in a row. “All
I do is care for others. Who cares for
me?” she thinks.
One of Maya’s patients is a fresh
post-operative coronary artery bypass
graft (CABG) patient. Maya knows her
night will be directed toward extubation, removing central lines, and getting
the patient ready to move out of the
ICU. Her other patient is Mr. Henry
who has been in the ICU for weeks.
Mr. Henry suffered a massive stroke
following mitral valve replacement
surgery and is paralyzed on one side,
unable to follow simple commands. He
remains ventilator dependent and is
being tube fed. Nursing staff are
frustrated with the family, especially
Mrs. Henry whom staff members feel
is anxious and demanding.
What can help Maya show compassion as she crosses the threshold of
her patients’ rooms during the next
12 hours? How can she attend to
Lyn Stankiewicz Murphy, PhD,
MBA, MS, RN, is an assistant professor
and director of the Health Services,
Leadership, and Management program,
University of Maryland School of Nursing (UMSON), Baltimore, Maryland. Lyn
attends Mountain Christian Church in Joppa, Maryland
and is involved in European and local missions.
Mark Walker, MS, RN, CNL, works in
the Surgical IMC Unit at University of
Maryland Medical Center and teaches
adult health clinical, nursing fundamentals, and health assessment labs for
UMSON.
*Names have been changed to protect patient privacy.
Accepted by peer review 2/25/13.
Supplemental digital content is available for this
article. Direct URL citations appear in the printed text
and are provided in the HTML and PDF versions of
this article at journalofchristiannursing.com.
The authors declare no conflict of interest.
DOI:10.1097/CNJ.0b013e318294c289
journalofchristiannursing.com JCN/July-September 2013 145
Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited.
146 JCN/Volume 30, Number 3 journalofchristiannursing.com
Religion is defined by a set of
beliefs, texts, rituals, and other practices
that a particular community shares
regarding its relationship with the
transcendent. Religion is a unified
system that is united into one moral
community (Musick, Traphagan,
Koenig, & Larson, 2000). Religion may
be the means by which many express
their spirituality. Similarly, there are
very spirited individuals who do not
follow a religion, and some religious
practices may not be very spiritual for
some people. Regardless of the term,
the issue at hand is that for a major
segment of the population, these
constructs must be understood as
part of the holistic perspective of the
person’s health.
WHOLE PERSON CARE
Spiritual care has been described as
a distinct type of care defined by acts
of listening, compassionate presence,
open-ended questions, prayer, use of
religious objectives, talking with
clergy, guided visualization, contemplation, meditation, conveying a
benevolent attitude, or instilling hope
(Chan, 2010; Puchalski & Ferrell,
2010). Spiritual care is helping the
patient make meaning out of his/her
experience or find hope. It involves
caring for the soul in a special kind of
engagement that goes beyond seeing
the physical patient in front of us; it is
observation of the entire patient
with the entire nurse. This has been
described as holistic nursing (Dossey
& Keegan, 2012; Quinn, 1981;
Watson, 2009).
This begs the question of whether
nurses separate their “physical caregiving” such as patient assessments,
turning and positioning, and dressing
changes from their “spiritual caregiving”
such as holding a patient’s hand, active
listening, or offering presence. This
depends greatly on the nurse and his or
her focus, and how he or she thinks
about and approaches the patient.
Christian nurses can look to Christ
to understand whole person care. Jesus
was a true whole person healer who
where providers are most focused on
and comfortable with diagnosing and
treating physical conditions. However,
care should be “patient-centered,
customized according to patient needs,
values, choices, and preferences,”
where the “system should anticipate
patient needs, rather than reacting to
events” (IOM, 2001, p. 3). From this
perspective, nurses are challenged to
deliver care that goes beyond the
diagnosis and treatment of physical
illness. Rather, care should incorporate
“the spiritual dimension in nursing’s
tradition which cannot be separated
from the science of nursing”
(Bradshaw, 1994, p. 169).
Spiritual care “involves serving the
whole person – the physical, emotional, social, and spiritual” (Puchalski,
2001, p. 352). Spiritual nursing care
consists of the activities of care that
bring quality of life, well-being, and
function to patients (Taylor, 2002).
Note that spiritual care may include
the transcendent, meaning making, and
religion. Researchers have repeatedly
demonstrated that patients and families
are particularly inclined to engage in
religious or spiritual guidance during
stressful life events such as healthcare
crises, illness, or death (Koenig, King, &
Carson, 2012). Moreover, 70% of the
U.S. population identifies with a
personal God and an additional 12%
believe in a higher power (Kosmin &
Keysar, 2008). Undoubtedly spiritual
care is important, yet these core values
and principles that “differentiate
nursing from other professions may
have been eroded in contemporary
practice” (Timmins & McSherry,
2012, p. 953).
Sadly, only 12% to 14% of nurses
report receiving spiritual training as
part of their nursing education
(Balboni et al., 2013). Although
numerous studies reveal religious or
spiritual coping helps patients, spiritual
care is not seen as a priority due to
lack of time (Chan, 2010). Nurses also
are reluctant to provide spiritual care
to their patients for fear of “stirring
things up that they will not know
how to address” (Jackson, 2011, p. 4),
crossing professional boundaries
(Carr, 2010), or not having access to or
knowing how to utilize spiritual care
experts (Puchalski & Ferrell, 2010). So
although nurses have a strong understanding of the importance of holistic
care and agree that providing spiritual
care is critical to patient care, not all
nurses believe they can provide
spiritual care. Nurses who do give
spiritual care provide it infrequently
and often feel inadequate (Cockell &
McSherry, 2012; Wright, 2005).
It’s important to note that spirituality is a broader concept than religion.
Smith (2006) defined spirituality as
“the matter by which a person seeks
meaning in their lives and experiences
transcendence, the connectedness to
that which is beyond” (p. 41). Similarly,
Sulmasy (2009) summarized spirituality
“as the way in which a person habitually conducts his or her life in relationship to the question of transcendence”
(p. 1635). Spirituality embraces the
understanding of one’s place in the
universe and the motivational and
emotional foundation for the lifelong
quest for hope and life’s meaning. In
other words, spirituality represents the
“innate human search for the meaning
and purpose of life” (Sadler & Biggs,
2006, p. 270).
Much of today’s
healthcare
continues to
be based on a
“medical model.”
Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited.
journalofchristiannursing.com JCN/July-September 2013 147
called to care for others out of a sense
of duty or service to a divine purpose.
In the first century, Jesus called his
followers to spread the gospel and heal
the sick (Shelly & Miller, 2006). This
calling influenced Florence Nightingale,
who integrated religiously defined
values and spiritual underpinnings with
principles of nursing practice. Although
Nightingale did not require that nurses
practice a religion, her selection of
those individuals considered suitable
for the nursing role was based on
Judeo-Christian ethics and morals
(Widerquist, 1992).
Spiritual care experts agree that
some progress has been made in
integrating spirituality in nursing care
(Barnum, 2011; Clarke, 2009; Koenig,
2007), but there is “lack of movement
and growth with little evidence of there
being a positive movement towards a
new phase of development” (Clarke,
2009, p. 1666). In other words, although
most nurses know about spirituality,
there remains “ambiguity about how it
is included in practice” (Clarke, 2009,
p. 1666). This is evidenced by the fact
that although nurses have a longstanding and ongoing commitment to the
spiritual dimension of a patient’s care
(Carson & Koenig, 2008; Taylor, 2006),
they do not consistently integrate
spirituality into their practice (Cockell
& McSherry, 2012).
Similarly, Watson (2009) posited that
“nurses are torn between the human
caring values and the calling that
addressed all the needs of those he
healed—physical and spiritual. For
example, in Luke 5:17–26, Christ
healed a lame man not only physically,
but spiritually. For nurses with a
foundation in Christianity, we strive
to live a Christ-like life, treating others
as Christ would (John 13:34-35). We
strive to think and act like Christ
because the Holy Spirit of God
lives within us (John 14:16-17; 1
Corinthians 3:16).
We propose that for the Christian
nurse, this type of whole person
nursing can be described as Spiritguided care. Spirit-guided care is the
act of removing one’s self as the
motivating force and allowing Christ,
in the form of the Holy Spirit, to
flow through us and guide us in our
care. It is entering into the sacred
work of God, “standing on holy
ground” (O’Brien, 2011, p. 2). In
doing so, we are able to draw on
God’s strength through the Holy
Spirit, and provide care that is truly
holistic in the sense that Christ meant
care to be. The foundation of Spiritguided care is how the nurse uses
him or herself as Christ’s hands and
presence as he or she engages in
nursing care.
Spirit-guided care means simultaneously focusing on and caring for the
whole patient and family. Rather than
approaching care as a series of tasks or
compartmentalizing aspects of care,
Spirit-guided care conceptualizes the
whole person in every caring act.
Taking a blood pressure becomes an
opportunity for presence and spiritual
assessment; offering presence is seen as
a way to impact blood pressure and
pain levels. Instead of thinking “I’ll
think about spiritual care after I get
meds passed” the nurse consciously
thinks, “What are this patient’s needs,
fears, distresses, questions?” as she or he
gives each medication, checks every
pulse. Every patient interaction involves
the whole person.
Providing this level of care
focuses on being as opposed to doing.
Although this is not a new concept to
nursing theory and many have taken
on the task of describing holistic care,
Spirit-guided care is an attempt to
describe care by the Christian nurse
for the whole patient that is guided
by the Holy Spirit. To understand
the differences between Christian
and secular perspectives of holistic
care, see “Holistic or Wholistic?”
in this issue of JCN (SchoonoverShoffner, 2013).
HISTORIAL PERSPECTIVES
Spiritual, whole person care has
existed throughout the history of
nursing (Miner-Williams, 2006;
Narayanasamy, 2004). In Greek and
Roman times, prayers to “God or gods
were considered an essential part of
nursing care” (Sawatzky & Pesut, 2005,
p. 21). For centuries, nursing has been
considered a calling; individuals were
While most nurses know
about spirituality, there
remains “ambiguity about
how it is included in practice.”
Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited.
center core surrounded by five
interrelated variables that protect the
core, one of which is spirituality.
Similarly, Parse’s Theory of Human
Becoming and Watson’s Theory of
Human Caring contain the construct
of spirituality (Martsolf & Mickley,
1998). McSherry and Draper (1998)
postulated that the spiritual dimension
of nursing care is grounded in the
scientific approach.
Florence Nightingale (1860) posited
that “nursing was a means of harmonizing oneself with the divine source
of all existence and, thus, it is a sacred
process” (Macrae, 2001, p. 19) and “the
integration of body, mind, and spirit
brings a sense of wholeness or completeness within oneself” (p. 72). From
attracted them to the profession, and
the technologically, high-paced,
task-oriented biomedical practices and
institutional demands, heavy patient
load, and outdated industrial practice
patterns” (p. 467). We know patients
welcome inquiry about their religion
or spiritual concerns from their
providers (Astrow, Wexler, Texeira,
He, & Sulmasy, 2007; Koenig, 2007);
however, most providers do not engage
in this type of discussion. It also seems
that nursing may be “shrugging off
its spiritual heritage” (Timmins, 2011,
p. 162) in an attempt to embrace the
science of nursing.
Given current challenges, our
healthcare system may seem incompetent and unprepared to address the
spiritual needs of our patients. The
Joint Commission requires spiritual
assessments in hospitals, nursing homes,
home care organizations, and agencies
providing addiction services (Hodge &
Horvath, 2011). Although the purpose
of administering these assessments is to
identify a patient’s spiritual needs and
determine the appropriate steps to
meet needs that emerge, because of
the lack of training and emphasis on
spirituality it is feared these needs are
not being met.
THEORETICAL PERSPECTIVES
Many nursing conceptual frameworks imbed the concept of spirituality. In the Neuman’s System model,
the client system is depicted as a
Offering Spirit-Guided Care
Maya tiredly walked to the Surgical ICU for her
third 12-hour night shift in a row. Working
7 p.m. to 7 a.m. was not her first choice; however, it fits her family’s needs. Lately, managing everyone’s
schedule has become overwhelming. “All I do is care for
others. Who cares for me?” she thinks. She breathes a sigh
of relief knowing that she is off for the next 4 days.
As Maya reviews her assignments, she thinks, “A
double assignment! Why me?” Having two critical patients
is doable but tough. One is a fresh post-operative CABG
patient. Maya knows her night will be directed toward
extubation, removing central lines, and getting the patient
ready to move out of the ICU. Her other patient has been in
the ICU for weeks.
Mr. Henry suffered a massive stroke 2 days following
mitral valve replacement and is paralyzed on one side,
unable to follow simple commands. He remains ventilator
dependent and is being tube fed. Everyone agrees the ICU
is not the proper place for Mr. Henry, but the family is concerned he would not receive the same care on the Stroke
Unit that he is receiving in the ICU. Mr. Henry’s son and
daughter-in-law are expecting their first child in 2 months.
Mrs. Henry feels that if her husband stays in the ICU, he
will receive the care he needs and be healthy enough to
hold his first grandchild.
Many of the nurses refer to Mr. Henry as “the ‘chron’ in
Room 3”—their term for a chronic ICU patient. The nurse
manager has complained the ICU is “losing money on him
every day.”
Mrs. Henry stays at her husband’s bedside during
daylight hours, often reading to him from the Bible. She
has requested the nurses read to Mr. Henry if they have
148 JCN/Volume 30, Number 3 journalofchristiannursing.com
Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited.
journalofchristiannursing.com JCN/July-September 2013 149
Nightingale’s perspective, this is the
essence of nursing practice.
Quinn (Macrae, 2001, p. 70)
identified three behavioral modes
under which nurses can practice. In
the first, known as the “sympathetic
mode,” the nurse feels sorrow toward
the patient, identifies directly with the
patient, and through the care process
adopts the hopes and fears of the
patient. Often, these “feelings of the
patient remain with the nurse, even
while at home,” which creates emotional distress for the nurse (Macrae,
2001, p. 71). Although compassion
allows providers to connect with their
patients, being overly responsive in
their compassionate role may result
in negative consequences such as
time. Maya has heard nurses tell Mrs. Henry “reading from
the Bible is not part of their scope of practice.”
Maya has cared for Mr. Henry many times, enjoys talking
with Mrs. Henry about their mutual faith, and has prayed
with the Henry family. Many of the nurses in the unit are
Christ-followers; however, the unit focuses primarily on the
physical needs of the patients with the goal to transfer as soon
as possible. The nurse giving Maya report whispers, “Good
luck! Mrs. Henry seems to think we have nothing better to do
but talk and hold her husband’s hand.”
Knowing she feels overwhelmed, Maya takes a moment
to silently and intentionally ask God to be with her, give her
extra strength, help her manage time well, and see needs
around her as God does. She recites Matthew 11:28-30
to herself. As she goes in to the post-CABG patient, she
introduces herself and takes his hand even though he remains
heavily sedated. She gently explains what she is doing as
she completes a head-to-toe assessment and checks equipment. Upon leaving, Maya squeezes his hand and tells him
she’ll be back shortly.
As she enters Mr. Henry’s room, Maya quietly asks God to
guide her interactions and bless this family. Maya asks Mrs.
Henry how she and her husband are doing today. She notices
that Mrs. Henry’s eyes are teary and asks, “How can I help?”
Mrs. Henry responds she knows what the nurses say. Maya
closes the door, takes Mrs. Henry’s hand, and sits with her for
a moment, actively listening. She tells Mrs. Henry she knows
“we sometimes seem gruff,” reassuring Mrs. Henry she understands her concerns and will care for her husband as Mrs.
Henry desires. Knowing their mutual faith, Maya reassures
Mrs. Henry that God loves Mr. Henry and has a plan. She
reminds Mrs. Henry of Psalm 23 and they recite this together.
Maya goes on to talk about the care plan for the night as she
assesses Mr. Henry.
Maya works hard to extubate her post-operative patient
and by morning he is sitting up ready to be transferred to the
cardiac rehab unit. Prior to leaving his room for the last time,
Maya takes her patient’s hand and says she wishes the best
for him. He responds, “I know I was not really awake, but I
knew you were here all night, in a comforting sort of way…I
was afraid but sensed you wouldn’t let anything bad happen.
Thank you.”
Maya smiles and says, “That’s what nursing is supposed
to be.”
Before going to report, Maya sees Mrs. Henry and asks
why she is here so early. Mrs. Henry replies, “I need to thank
you…you were so busy last evening yet took the time to talk
and give my husband a bath and make him comfortable. I
have been thinking about what you said about God helping
us and I would like to go up and take a tour of the Stroke
Unit, maybe Mr. Henry would be okay up there….”
As Maya reports to the oncoming shift the nurse manager
says, “Wow! You must be a miracle worker – both of these
patients may move out of the unit today!” Maya smiles and
thinks, “No, I am not a miracle worker, but my God is…”
Reflection Questions:
• Identify ways Maya provided spiritual whole person care.
• What is unique about Maya’s approach to holistic care?
• What did Maya do to provide Spirit-guided care?
• What does Maya need to do to continue caring as she did
this shift?
• How might Maya help her colleagues move from a “defensive mode” to provide holistic care?
The foundation of
Spirit-guided care
is how the nurse
uses him or herself
as Christ’s hands
and presence as
he/she engages in
nursing care.
journalofchristiannursing.com JCN/July-September 2013 149
Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited.
150 JCN/Volume 30, Number 3 journalofchristiannursing.com
(Luke 9:6, NKJV), and is carried
through to the last book of the Bible
speaking of healing and no more death
when Christ returns to earth (Revelation 21, 22). As Christian nurses, we are
called to carry God’s healing power to
our patients (Matthew 25:31-46; Luke
10:25-37).
The book of Acts begins the story
of God the Spirit, the Holy Spirit in us
who believe in Jesus Christ. Christians
are not simply spectators; rather we
are acting as Christ would act through
the Spirit within us (John 14). God
enables us to live a life of respect,
obedience, and kindness from being
reborn through Jesus and renewed by
the Holy Spirit who has been poured
out on us (Titus 3:1-8). As we live a
Spirit-guided life, God shows the
reality of his presence through us. For
study on how God guides Christians
through the indwelling Holy Spirit,
see the online guide provided as
Supplemental Digital Content at
http://links.lww.com/NCF-JCN/A23.
IMPLEMENTING
SPIRIT-GUIDED CARE
Whole person care is not at the
forefront of nursing care delivery or
education (Carlyle, Crowe, & Deering,
2012; Chan, 2010; Elliott, 2011), so
where does this type of care begin?
Miner-Williams (2006) concluded
that nurses can “provide spirited
nursing care and nursing care spiritually” (p. 818). The challenge, however, is
that the nurse must be at ease with
compassion fatigue (Slatten, David
Carson, & Carson, 2011; Yoder, 2010).
In the “defensive mode” the needs
of the patient create anxiety in the
nurse, which results in an unconscious
display of self-protective behaviors.
These behaviors manifest themselves
as “emotional distancing, excessive
task-orientedness, and derogatory
labeling of the patient such as demanding, uncooperative, or inappropriate”
(Macrae, 2001, p. 71). All of us have
encountered nurses who at times (or
regularly) do not practice from the
caring perspective, having become
hardened, brittle, worn-down, and
almost robot-like in the context of
providing care.
Lastly, Quinn (1981) identified the
“holistic mode” in which the nurse
embraces the patient’s body, mind, and
spirit, and, as a result, acts in a highly
conscious and compassionate manner.
The nurse identifies with his or her
own self and with the patient’s state of
well-being. When this self-awareness
occurs, the nurse is able to move beyond
the typical triggers that initiate the
sympathetic and defensive modes and
function from a holistic perspective.
These theoretical perspectives
speak to whole person care and
describe in part, Spirit-guided care.
However, the theories do not fully
encompass a Christian perspective
and what is intended by Spirit-guided
care, that is, the Holy Spirit dwelling
within the Christian nurse and
guiding his or her care. To understand
Spirit-guided care we must turn to
the Bible.
BIBLICAL PERSPECTIVES
The Old Testament makes it clear
that God the Father wants to promote
health and address whole person
needs. Leviticus addresses numerous
health-related concerns as God
presented directives for food, waste,
childbirth, and infections. The Psalms
contain prayers about holistic healing,
such as “O Lord, my God, I cried out
to You, and You healed me” (Psalms
30:2, NKJV), and “He heals the
brokenhearted and binds up their
wounds” (Psalms 147:3, NKJV).
Proverbs provide wisdom regarding
healthy living and Jeremiah confirms
God, the Father, is the source of all
healing, as “Behold, I will bring health
and healing; I will heal them and
reveal to them the abundance of
peace and truth” (Jeremiah 33:6,
NJKV). God heals people physically,
emotionally, and spiritually throughout the Bible.
The New Testament is replete with
examples of God the Son’s healing
intention and power. Starting in
Matthew, we see “Jesus went about all
Galilee, teaching in their synagogues,
preaching the gospel of the kingdom,
and healing all kinds of sickness and all
kinds of disease among the people”
(Matthew 4:23, NKJV). This theme is
continued in Luke, “So they departed
and went through the towns, preaching
the gospel and healing everywhere”
Spirit-guided care is the act of
removing one’s self as the motivating
force and allowing Christ, in the form
of the Holy Spirit, to flow through us
and guide us in our care.
Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited.
journalofchristiannursing.com JCN/July-September 2013 151
spirituality and what it means to the
patients that are being cared for.
Jackson (2011) suggested that nurses
“all have the ability to give quality
spiritual care [at some level], because
what is needed is simply to be present,
to listen, and to offer compassion”
(p. 4). Given that these skills are basic
tenets of nursing, the act of caring is
found at the heart of caring for the
whole person.
To provide Spirit-guided care,
nurses must attend to their own
spiritual self-care. Authors from both
Christian and secular perspectives
discuss the importance of the nurse
engaging in spiritual self-care (Barnum,
2011; Dossey & Keegan, 2012; Shelly
& Miller, 2006; Taylor, 2007). For
Christians, spiritual self-care involves
personal time with God in Bible
study, prayer, worship, fellowship
with other believers, and Sabbath rest.
MacKinlay (2008) further posited that
the simple act of providing care can
help the nurse promote his or her
own spiritual well-being. Healthcare
organizations can recognize the value
of Spirit-guided care by integrating
spirituality into communiques and
workshops to raise nurses’ awareness
of spirituality—in them and their
patients.
Spirit-guided care involves a decision
the Christian nurse makes the moment
his or her feet cross the threshold of the
patient’s doorway. It is the conscious
decision to simultaneously tend to the
whole patient including that which is
unseen. Spirit-guided care requires the
nurse to draw on faith in God and how
he relates to us not only as physical
beings, but as spiritual beings. In this
light, the true essence of nursing is
understood—the focus on the total care
of every individual patient from every
aspect of the patient (Sheldon, 2000).
Spirit-guided care is providing care in
God’s presence where there is complete fullness of joy and we are able to
love others because he first loved us
(1 John 4:19).
The first step toward the process
of promoting Spirit-guided care is
making the conscious decision to
allow the Holy Spirit to flow through
and be part of care delivery. This is a
mindset that begins with the nurse’s
self-awareness and the awareness of
the “transcendent dimension of life
that is reflected in the patient’s
reality” (Sawatzky & Pesut, 2005,
p. 23). It is the connection of the
nurse to truly be the hands and feet
of Christ to holistically intervene to
restore and maintain the patient’s
whole being, not simply his/her physical
being. Providing Spirit-guided care
encompasses the acts of Christ as a
foundation for our professional
practice.
Using the nursing process as a
framework, we can better understand
the integration of Spirit-guided care
into care delivery. Spirit-guided care
means entering into assessment
attentive to the whole patient and his
or her family. Most general admission
assessments include asking about
spiritual history as a brief screening
tool, and a number of models are
available for deeper spiritual assessment
(Puchalski & Ferrell, 2010). This
spiritual history, screening, or assessment may act as a cue to engage the
nurse with the patient in spiritual
whole person care (Burkhart & Hogan,
2008). Spiritual distress, risk for
spiritual distress, and readiness for
enhanced spiritual well-being are
North American Nursing Diagnosis
Association (NANDA) nursing
diagnoses that address the construct of
spirituality. These diagnoses are most
commonly referred to having spiritual
pain, anger, loss, and despair, with the
signs and symptoms including a broad
range of emotions such as crying,
withdrawing, preoccupation, anxiety,
hostility, apathy, and feeling of pointlessness and hopelessness (Ackley &
Ladwig, 2013).
The next steps of the nursing
process focus on planning and implementation. Burkhart and Hogan
(2008) describe the role of the nurse as
two-fold in planning/implementation:
(1) creating an environment to increase
the likelihood that a patient will
engage in the care process and
(2) crafting her or his care. Engaging
in Spirit-guided care would mean
the nurse would privately ask God
(prayer) what would best meet patient
needs along with using nursing
knowledge and skill to plan and
implement care.
The nurse can evaluate the
outcomes of care based on the
patient’s response. Again, Burkhart and
Hogan (2008) view this as a “positive
or negative emotional response,”
which then leads to “searching for
meaning in the encounter,” “formation of spiritual memory,” and “nurse
spiritual well-being” (p. 931). In this
light, Spirit-guided care should
facilitate connections to and among
the patient, the nurse and other
providers, the family, the larger
community, and with God and the
patient’s search for meaning.
It is surprising that more schools of
nursing do not include the construct
of spirituality in their curriculum.
Callister, Bond, Matsumura, &
Mangum (2004) found that among
132 baccalaureate nursing programs in
the United States, few had defined
spiritual nursing care in their programs
and fewer reported learning opportunities about spirituality and spiritual
interventions imbedded in their
curriculum. Sadly, educators continue
to report that little attention is given
to spirituality in nursing education
(Balboni et al., 2013).
How could this be changed?
Students could be encouraged to reflect
on their own spirituality and how they
interpret their clinical experience as it
pertains to spirituality. This reflection
will provide a growing awareness, allow
students to understand their frame
of reference, and more comfortably
integrate whole person care into their
nursing practice. However, rather than
leaving it to chance, learning how
to provide spiritual care should be
included in nursing curricula and
institutional programming (Burkhart &
Hogan, 2008).
Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited.
152 JCN/Volume 30, Number 3 journalofchristiannursing.com
CONCLUSION
Return to Maya and her 12-hour
shift. What needs do her patients and
their families have? What would help
Maya offer Spirit-guided, whole
person, integrated care? What would
Spirit-guided care look like? Find
exploration of this case study in the
sidebar “Offering Spirit-Guided Care.”
Spirit-guided care exists within the
context of the nurse–patient relationship where all interactions with the
patient may be understood as implicitly
spiritual. Simple things such as empathy, warmth, genuineness, and kindness
contribute to relationship, which in
turn can help meet patients’ spiritual
needs, particularly in situations where
the patient is isolated from his or her
family and community and a meaningful relationship has developed with the
nurse (Hodge & Horvath, 2011).
Given the challenges of today’s
healthcare organizations, nurses are
being called to work more efficiently
and effectively while maintaining high
quality care. As Christian nurses, this
charge is imbedded within our nursing
practice by way of our Christian faith.
We are challenged to “rejoice always,
pray without ceasing, in everything, give
thanks; for this is the will of God in
Christ Jesus for you” (1 Thessalonians
5:16-18, NKJV). Spirit-guided care
is an ethical obligation of Christian
nurses to deliver care as the hands
of Christ once did. Our ability to
incorporate Christ and his healing
power into our professional nursing
practice not only fosters better
outcomes for the patient, but reflects
our commitment as Christians to
demonstrate his love.
Ackley, B. J., & Ladwig, G. B. (2013). Nursing diagnosis
handbook: An evidence-based guide to planning care (10th
ed.). Maryland Heights, MO: Mosby Elsevier.
Astrow, A. B., Wexler, A., Texeira, K., He, M. K., &
Sulmasy, D. P. (2007). Is failure to meet spiritual needs
associated with cancer patients’ perceptions of quality of
care and their satisfaction with care? Journal of Clinical
Oncology, 25(36), 5753–5757.
Balboni, M. J., Sullivan, A., Amobi, A., Phelps, A. C.,
Gorman, D. P., Zollfrank, A., …, Balboni, T. A. (2013).
Why is spiritual care infrequent at the end of life?
Spiritual care perceptions among patients, nurses, and
physicians and the role of training. Journal of Clinical
Oncology, 31(4), 461–467.
Barnum, B. S. (2011). Spirituality in nursing: The challenges
of complexity (3rd ed.). New York, NY: Springer.
Bradshaw, A. (1994). Lighting the lamp: The spiritual
dimension of nursing care. London: Scutari Press.
Burkhart, L., & Hogan, N. (2008). An experiential
theory of spiritual care in nursing practice. Qualitative
Health Research, 18(7), 928–938.
Callister, L. C., Bond, A. E., Matsumura, G., & Mangum,
S. (2004). Threading spirituality throughout nursing
education. Holistic Nursing Practice, 18(3), 160–166.
Carlyle, D., Crowe, M., & Deering, D. (2012). Models of
care delivery in mental health nursing practice: A mixed
method study. Journal of Psychiatric and Mental Health
Nursing, 19(3), 221–230.
Carr, T. J. (2010). Facing existential realities: Exploring
barriers and challenges to spiritual nursing care.
Qualitative Health Research, 20(10), 1379–1392.
Carson, V. B., & Koenig, H. G. (Eds.). (2008). Spiritual
dimensions of nursing practice. West Conshohocken, PA:
Templeton.
Chan, M. F. (2010). Factors affecting nursing staff in
practising spiritual care. Journal of Clinical Nursing,
19(15–16), 2128–2136.
Clarke, J. (2009). A critical view of how nursing has
defined spirituality. Journal of Clinical Nursing, 18(12),
1666–1673.
Cockell, N., & McSherry, W. (2012). Spiritual care
in nursing: An overview of published international
research. Journal of Nursing Management, 20(8), 958–969.
Dossey, B. M., & Keegan, L. (2012). Holistic nursing: A
handbook for practice. Burlington, MA: Jones & Bartlett.
Elliott, H. (2011). Moving beyond the medical model.
Journal of Holistic Healthcare, 8(1). Retrieved from http://
www.martinsey.org.uk/pdf/moving.pdf
Hodge, D. R., & Horvath, V. E. (2011). Spiritual needs
in health care settings: A qualitative meta-synthesis of
clients’ perspectives. Social Work, 56(4), 306–316.
Institute of Medicine. (2001). Crossing the quality chasm:
A new health system for the 21st century. Washington, DC:
National Academy of Sciences.
Institute of Medicine. (2010). The future of nursing:
Leading change, advancing health. Washington, DC:
National Academy of Sciences.
Jackson, C. (2011). Addressing spirituality: A natural
aspect of holistic care. Holistic Nursing Practice, 25(1), 3–7.
Koenig, H. G. (2007). Spirituality in patient care: Why, how,
when, and what. West Conshohocken, PA: Templeton.
Koenig, H. G., King, D. E., & Carson, V. B. (2012).
Handbook of religion and health (2nd ed.). Oxford, UK:
Oxford University.
Kosmin, B., & Keysar, A. (2008). American Religious
Identification Survey. Hartford, CT: Trinity College.
MacKinlay, E. (2008). Practice development in aged care
nursing of older people: The perspective of ageing and
spiritual care. International Journal of Older People Nursing,
3(2), 151–158.
Macrae, J. (2001). Nursing as a spiritual practice: A
contemporary application of Florence. Springer.
Martsolf, D. S., & Mickley, J. R. (1998). The concept of
spirituality in nursing theories: Differing world-views and
extent of focus. Journal of Advanced Nursing, 27(2), 294–303.
McSherry, W., & Draper, P. (1998). The debates
emerging from the literature surrounding the concept
of spirituality as applied to nursing. Journal of Advanced
Nursing, 27(4), 683–691.
Miner-Williams, D. (2006). Putting a puzzle together:
Making spirituality meaningful for nursing using an
evolving theoretical framework. Journal of Clinical
Nursing, 15(7), 811–821.
Musick, M. A., Traphagan, J. W., Koeing, H. G., & Larson,
D. B. (2000). Spirituality in physical health and aging.
Journal of Adult Development, 7(2), 73–86.
Narayanasamy, A. (2004). The puzzle of spirituality for
nursing: A guide to practical assessment. British Journal of
Nursing, 13(19), 1140–1144.
Nightingale, F. (1860). Notes on nursing: What it is, and
what it is not. Philadephia, PA: Lippincott.
O’Brien, M. E. (2011). Spirituality in nursing: Standing on
holy ground. Sudbury, MA: Jones & Bartlett.
Puchalski, C. M. (2001). The role of spirituality in health
care. Baylor University Medical Center Proceedings, 14(4),
352–357.
Puchalski, C., & Ferrell, B. (2010). Making health care whole:
Integrating spirituality into patient care. West Conshohocken,
PA: Templeton.
Quinn, J. (1981). Client care and nurse involvement in a
holistic framework. In Dolores Krieger (Ed.),
Foundations of holistic health nursing practices: The renaissance
nurse. Philadelphia, PA: Lippincott.
Sadler, E., & Biggs, S. (2006). Exploring the links
between spirituality and ‘successful aging’. Journal of
Social Work Practice, 20(3), 267–280.
Sawatzky, R., & Pesut, B. (2005). Attributes of spiritual
care in nursing practice. Journal of Holistic Nursing, 23(1),
19–33.
Schoonover-Shoffner, K. (2013). Holistic or wholistic?
Journal of Christian Nursing, 30(3), p. 133.
Sheldon, J. E. (2000). Spirituality as a part of nursing.
Journal of Hospice & Palliative Nursing, 2(3), 101–108.
Shelly, J. A., & Miller, A. B. (2006). Called to care: A Christian
worldview for nursing. Downers Grove, IL: InterVarsity.
Slatten, L. A., David Carson, K., & Carson, P. P. (2011).
Compassion fatigue and burnout: What managers
should know. The Health Care Manager, 30(4), 325–333.
Smith, A. R. (2006). Using the synergy model to
provide spiritual nursing care in critical care settings.
Critical Care Nurse, 26(4), 41–47.
Sulmasy, D. P. (2009). Spirituality, religion, and clinical
care. Chest, 135(6), 1634–1642.
Taylor, E. J. (2002). Spiritual care: Nursing theory, research,
and practice. Upper Saddle River, NJ: Prentice Hall.
Taylor, E. J. (2006). Spiritual assessment. In B. R. Ferrell
& N. Coyle (Eds.), Textbook of Palliative Nursing (pp.
581–594). Oxford, England: Oxford University.
Taylor, E. J. (2007). What do I say? Talking with patients
about spirituality. West Conshohocken, PA: Templeton.
Timmins, F. (2011). Remembering the art of nursing in a
technological age. Nursing in Critical Care, 16 (4), 161–163.
Timmins, F., & McSherry, W. (2012). Spirituality: The
Holy Grail of contemporary nursing practice. Journal of
Nursing Management, 20(8), 951–957.
Watson, J. (2009). Caring science and human caring
theory: Transforming personal and professional practices
of nursing and health care. Journal of Health and Human
Services Administration, 31(4), 466–482.
Widerquist, J. G. (1992). The spirituality of Florence
Nightingale. Nursing Research, 41(1), 49–55.
Wright, S. (2005). The new truth. Why nurses are
playing a bigger role in spiritual care. Nursing Standard,
19(44), 28–29.
Yoder, E. A. (2010). Compassion fatigue in nurses.
Applied Nursing Research, 23(4), 191–197.
Copyright © 2013 InterVarsity Christian Fellowship. Unauthorized reproduction of this article is prohibited.
