Why Spiritual Care?

Staying connected to something greater.

In a world that is constantly asking more of us, how can we stay connected to ourselves, to something greater, to a sense of meaning and purpose in our lives? This question guides most of my work, and my personal practices. Across years of conducting mixed-methods research to explore the role of spirituality among people with cancer, I am constantly presented with ways where our connection to spirit is challenged, and ways that we can remain connected amidst the very real pain, challenge, busyness, stress, and burnout of this modern world.

Making time and space for spirituality may seem elusive or impractical, especially when considering the limitations on our time and capacities. Along with co-authors Katie Addicott, MSN, FNP-C, ACHPN, and William E. Rosa, PhD, MBE, AGPCNP-BC, FAANP, FAAN, my hope for this recent piece in the American Journal of Nursing is to highlight simple, practical, and enjoyable ways to incorporate spirituality into everyday life and everyday nursing care, with the intention of supporting our own well-being and the well-being of patients and families we work with.

Defining spirituality 

While various definitions have been offered, “spirituality” generally refers to a human experience of connection with self, others, nature and/or a higher power, and a sense of meaning or purpose. Put more simply, spirituality can be seen as our essential relationship with life—how we understand, make meaning of, and relate to events in our lives.

As you might expect, experiences of spirituality vary greatly from person to person, and are expressed through beliefs, values, rituals, traditions, and practices. It is also important to highlight that many people do not identify with the word “spirituality” at all. I use the term in a broad and inclusive way, acknowledging unique experiences of connection and meaning or purpose in each of our lives.

What is spiritual care? 

The immense experiences of suffering, grief, loneliness, and burnout among nurses today call for a reexamination not only of our care delivery systems, but also of the personal frameworks through which we approach our nursing practice. Evidence supports addressing spirituality as part of holistic palliative care nursing, yet we need to be careful that spiritual care doesn’t become another item on our to-do lists, but rather is practiced as an embodied way of being, part of our daily lives and moment-to-moment activities.

Cornerstones of spiritual care include presence, intentionality, and compassion.

• Presence is a practice of approaching others in a way that acknowledges and honors their holistic nature, and focuses on creating an interpersonal environment of authenticity.
• Intentionality includes holding a desire for the greatest good.
• Compassion involves bearing witness to another person’s lived experiences, seeking to understand their suffering, and acting in alignment with an intention to reduce suffering.

Attending to spiritual care is a core component of palliative nursing, as reflected in the Clinical Practice Guidelines for Quality Palliative Care from the National Coalition for Hospice and Palliative Care. Notably, these guidelines define the role of spiritual care in practice, such as assessing spiritual histories and screening for spiritual concerns, and they highlight the importance of nurses tending to our sense of spirituality as part of our professional role. Tending to our own spiritual care needs is a central part of sustaining our palliative nursing work and showing up from a place of authentic presence, intention, and compassion.

Putting spiritual care into practice

Despite limitations and practical barriers, there are many ways that we can bring spiritual care into our everyday lives and nursing practice. First, we can take a bit of time to tend to our own unique sense of spirituality. Some suggestions for putting this into practice include: being present with loved ones, engaging in contemplative practices, meditation, prayer (secular or religious), creating and/or viewing art, engaging in service activities for positive social change, practicing mindful exercise/movement, seeking pastoral care, counseling, and/or therapy, participating in rituals or ceremonies, and spending time in nature.

Moving from a place of self-awareness, it can then be useful to practice assessing spiritual care and spiritual care needs regularly within our nursing care environments. Various resources and guides are available to do this. Identifying which spiritual care resources are available can be especially useful when needs are identified, within ourselves and within the patients and families we work with. Building relationships with spiritual care specialists (chaplains, if available, or mental health clinicians) can be helpful as well so that we know that support is available when needed.

Palliative nursing and ‘a deep examination of priorities.’

As our schedules and to-do lists continue to fill up, the need for a connection to something greater may be more relevant than ever. Within my work in palliative nursing, I recognize that being close to suffering and mortality requires a high level of self-knowledge and self-care, and it also brings numerous gifts that have enhanced my life beyond measure. One of the greatest gifts brought by recognizing our shared relationship with suffering and mortality is a deep examination of priorities, which has the capacity to transform the way we live. By recognizing that suffering is a universal human experience, this shared vulnerability can connect us more deeply with the patients and families we serve and with the deeper roots of our nursing work.

I want to take a moment to honor the courage it takes to engage in palliative nursing today, and the ways our presence really can make a difference. Spiritual care starts with us.

Megan Miller, PhD, RN, is an assistant professor at the University of Wisconsin–Madison School of Nursing. Contact author: Megan Miller, miller89@wisc.edu. This text was deeply informed through collaboration with Katie Addicott, MSN, FNP-C, ACHPN, and William E. Rosa, PhD, MBE, AGPCNP-BC, FAANP, FAAN. Megan would like to offer gratitude and acknowledgement for their thoughtful contributions to this piece.