Nurses’ responses in spiritual encounters with patients, and issues that influenced these responses; a comparison of medical nurses, oncology nurses and Macmillan nurses

Abstract

Background Spiritual care is considered an important aspect of palliative care. Patients with heart failure have palliative care needs, but are more likely than those with cancer to be cared for on general wards. Aims To explore the responses of nurses in encounters that could be considered spiritual and issues that influenced these responses, and to explore the differences between medical ward nurses, oncology ward/department nurses and Macmillan nurses. Methods The Critical Incident Technique, with semi-structured interviews of 9 medical, 9 oncology and 9 Macmillan nurses. Demographical data was collected using a questionnaire. Setting A regional hospital and the Macmillan nursing service in the Highlands of Scotland. Results Nurses constantly negotiated the boundaries between what is and what is not appropriate in the nursing role. There was a tension between their role to respect patients’ beliefs and wishes and to minimise stress and suffering. The nurses were thrown into conflict when patients refused optimal symptom relief or when those who were not terminally ill refused life saving treatment. In this study, providing comfort, relieving suffering and saving lives that could be saved, took priority over patients’ religious and spiritual beliefs or wishes. The Macmillan nurses felt less responsible for providing answers or resolutions, and were more likely to use a pathway of listening, discussing, exploring and clarifying. The medical nurses worked in an environment that often was not conducive to provide spiritual care, with less access to support than the other nurses. Conclusion Medical ward nurses need appropriate support and preparation, as well as the time and space to provide holistic care. Some of the Macmillan nurses’ skills would be transferable to nurses working in any area of nursing. A greater understanding of the reasons for various religious beliefs and wishes may help nurses to accept them more fully, which may reduce stress both in nurses and patients.