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M aggie Miller is a 49-year-old woman with endstage ovarian cancer. Susan Johnson has been Ms. Miller's nurse throughout several hospital admissions. She's seen Ms. Miller's chronic pain worsen and, ultimately, become intractable. A bond has developed between the two women. One night, as Susan prepares to give her a back rub, Ms. Miller cries out in pain: I just wish it would end. I'm beginning to feel this constant pain is some sort of punishment from God. Why does He let me suffer like this? If Ms. Miller were your patient, would you know how to respond? Would you try to turn her attention to something else in hopes of evading the question? Or might you attempt to make her feel better by reassuring her that God wasn't punishing her? Imparting hope and assuaging fear have been important aspects of nursing since the days of Florence Nightingale. And when the North American Nursing Diagnosis Association (NANDA) made distress a nursing diagnostic category in 1988, it fell within our domain officially. Unfortunately, most nursing programs virtually ignore spiritual distress. In a 1990 national survey, nearly 97% of the 186 practicing, registered nurses who responded said they believed nurses should address a patient's spiritual needs, but only 66% of them felt prepared to do so. In this article, I'll discuss how to assess a patient's spiritual needs and recognize a spiritual crisis. I'll also illustrate ways you might effectively intervene in spiritual matters. The nurse: A primary source of hope One pilot study of postsurgical patients with cancer or heart disease suggests that the nurse may be a primary source of hope for patients and that nurses who impart hope can exert a very positive influence on recovery. Of the 15 patients interviewed, five said the mere presence of a nurse inspired hopefulness-especially when the nurse responded to their questions and had an upbeat or encouraging attitude. When Ms. Miller sought help from Susan, Susan responded by listening and encouraging her to express her feelings. She pulled a chair up to the bed and, without trying to ignore the crisis or fix it, gently urged Ms. Miller to talk about her spiritual pain. Susan knew from previous conversations that Ms. Miller was a Roman Catholic. Susan isn't a Roman Catholic, but she's comfortable praying with patients of different faiths. So she offered to pray with Ms. Miller, who eagerly accepted the invitation. The two joined hands. Susan initiated the session, praying aloud for a greater awareness of divine presence and a deeper understanding of divine love. This inspired Ms. Miller to pray aloud, too, expressing her anger, fear, and frustration. Afterwards, Ms. Miller relaxed into her pillow and thanked Susan for helping her shift her focus. Instead of dwelling on questions about why this was happening, she had moved on to constructive thoughts about how her disease could bring her and her family closer to God.
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