Nurses must be equipped with the appropriate training and resources to deliver spiritual care and support to patients during major health crises such as the coronavirus pandemic, a nursing academic has told.
Professor Irena Papadopoulos, professor of transcultural health and nursing at Middlesex University London, is one of the authors behind a newly-published study exploring the need for a “national strategy for the provision of spiritual care and support during major health disasters”.
“I really began to feel as the weeks went by that the emotional and spiritual care of patients and their families was hugely lacking”
Study participant
It draws upon the learnings and experiences of senior nurses and chaplains during March 2020 to July 2021, when unprecedented pressures and a lack of preparedness within the health system during the coronavirus pandemic saw spiritual care “drastically” diminish.
In an exclusive interview with Nursing Times, Professor Papadopoulos stressed that offering spiritual care and support to patients must became an “automatic habit” for nurses and that they needed the appropriate training and resources to do so, especially in times of a major health crisis.
During the research process participants gave a “variety of definitions and explanations” about what spirituality is, with many senior nurses linking the term to religion and sacraments for the dying, or practices related to funerals and bereavement.
Professor Papadopoulos said that although “a lot of people” thought spirituality was solely about religion, this was not the case, and that people who do not have a religion may still have spiritual needs.
To address this, the research team created a new definition for the term, which they want to be adopted nationally to stamp out variation.
The definition reads: “Spirituality is an integral part of all human beings which is connected to religions, faiths, personal philosophies, a relationship with ourselves, others and the environment, as well as a relationship with a transcendent superior force, which helps us understand the meaning and purpose of our existence and that of others.”
As part of the study, nurses reflected on how the pandemic had negatively impacted their ability to provide what they defined as spiritual care, especially in terms of end-of-life care.
Senior nurses described feeling “professionally and emotionally overwhelmed” by the number of deaths they were seeing, which was further exacerbated by the fact that many patients were dying alone, without their relatives.
“It was quite shocking in terms of what we normally do, the change, the contrast. I really began to feel as the weeks went by that the emotional and spiritual care of patients and their families was hugely lacking,” said one interviewee.
Another said: “We tried our best to stay with the dying person, as we wanted to comfort them and ease their fear of death by holding their hand or reading a prayer, but too often this was not possible as we were overwhelmed by all the physical care other patients needed to stay alive.”
“Spiritual care and suppost needs to become part of the automatic habits that healthcare professionals have”
Irena Papadopoulos
Other interviewees highlighted the negative impact of visiting restrictions and a lack of personal protective equipment (PPE), which in some hospitals prevented chaplains seeing patients or staff face to face.
The research, funded by the Burdett Trust for Nursing, reiterated that while the demand for spiritual care and support “grows exponentially” during major health disasters, the “emergency burden of care and focus on preserving life often hamper its provision”.
The majority of interviewees said that while their employer had policies or strategies for major incidents, these failed to include information about the provision of spiritual care and support. Some were not aware of any relevant spirituality strategies in their workplace prior to the pandemic.
One senior nurse described how regardless of the pandemic, “spirituality training for nurses has been very superficial” and said there was “very little content on pain and suffering in the nursing curriculum”.
Throughout the research, nurses and chaplains agreed there was a need for a national strategy to bring about change and ensure they had appropriate resources, training, skills, and a standardisation of processes to deliver spiritual care and support during any future crises.
Within such strategy, the study recommends that all nurses should have spirituality training to “develop the awareness and understanding of what it means”. The study adds that chaplains, who are expert in this field, must be involved in the delivery of this training.
In addition, it suggests steps be taken to ensure nursing staff always carry out a spiritual and religious assessment of patients’ needs, which should be recorded in official patient records.
Going forwards, Professor Papadopoulos told Nursing Times that spiritual care needed to “become part of the automatic habits that healthcare professionals have”, so that no matter what the situation is, patients will be asked about their spiritual needs.
Irena Papadopoulos
“Spirituality doesn’t need a special place or a special time,” she said. “If you know the importance of it, you do it while you do other things, you say in a nice word, or you ask a little question, or while you’re turning your patient… that kind of thing.”
She acknowledged that in some areas there had been an “attempt” to train nurses in this field, but it was not always necessarily transferring into practice.
“When a patient comes into hospital, nurses will assess the patient and ask, ‘can you eat, do you have pain, can you breathe’… [but] there is no where that the patient is assessed about their spiritual needs,” she added.
Chaplains had subsequently suggested nurses ask two or three simple questions around religion or spirituality to ensure this part of them was being acknowledged and cared for.
Almost all interviews said employers recognised that staff themselves also needed some form of “psycho-spiritual support” and areas for “contemplation and group discussions”, following the challenges and pressures of working during the pandemic.
Professor Papadopoulos recognised that some organisations had created garden areas and spaces where they could talk among themselves or with a chaplain.
However, while some trusts had as many as six chaplains supporting staff and patients, some did not have any because of Covid-19 restrictions, and so the provision of support available was mixed, she said.
Other recommendations for the national strategy suggested specific spiritual care and support protocols for staff in need of this type of care, such as those who become ill while providing care to patients, or who are working amid staffing shortages.
The study concludes by stating: “Catering for the spiritual needs of the affected population should be a key aspect of any emergency strategy, given the centrality of [spiritual care and support] in healthcare, which becomes both exceptionally important and challenging in circumstances of mass fear and death.”
