Faith and healing☆☆☆

Spirituality 

Spirituality is an essential aspect of being human, and wellness depends on the integrity and balanced interrelationship of all aspects of being human. Spirituality is not a healing mode per se but an aspect of life that may be “dis-eased” and therefore require healing.2 Drawing a line between patients' spiritual needs and medical needs is no longer sensible in any care setting. The common methods for spiritual healing are the spiritual disciplines of prayer/meditation, forgiveness, service, and religious practice.2 Because mind, body, and spirit are interdependent, imbalance in one will inevitably affect the others.

Most people have some religious or spiritual foundation in their lives, and health care professionals must not ignore that aspect of their patients. People experience spirituality in many ways: a belief in a power operating in the universe that is greater than oneself,3 an awareness of the purpose and meaning of life,4 a sense of interconnectedness with all living things, and the development of personal, absolute values. Although spirituality may be associated with religious practice, acts of compassion, altruism, and the experience of inner peace also are considered important aspects of spirituality.

Spirituality and health 

Many adults express increasing interest in the role of spirituality in their health and health care. Some experts believe that dissatisfaction with the impersonal nature of our medical system—and the fact that medical science does not have answers to all questions about the maintenance of health and well-being—may fuel this interest.4

Many people report that spirituality plays an important role in their lives. Research has found that 94% of respondents believe doctors should discuss religious beliefs with the seriously ill,5 64% think physicians should pray with patients who request it,6 and 45% say religion would influence their medical decisions if they were seriously ill.5 Likewise, 25% report that they use prayer as a healing therapy for themselves.7 Definitions of various spiritual terminology are shown in Table 1.

Table 1. Faith Terminology

	Spirit
	Considered the essential nature of a person
	Spiritual healing
	Intentional influence of 1 or more persons on another living system without using known physical means of intervention*
	Spiritual awareness
	Awareness of the intangible or that which is not material, especially of the ultimate meaning and purpose of life. There may be a heightened awareness of, and concern for such matters during times of illness or when facing death.
	Prayer
	Defined as openness to or communication with the transcendent; may be practiced within or outside of an organized religious context. Transcendence can be thought of as the nonmaterial or universal aspects of being that go beyond one's individual existence.
	Intercessory prayer
	Asking a higher power to intervene on behalf of (another) individual to benefit that person's well being.* Frequently used interchangeably in medical literature with distance healing. However, a distinction may be that distance healing refers to any “dedicated act of mentation,” not necessarily prayer in the classic sense of the word.* In either intercessory prayer or distance healing, the person performing the prayer or act of mentation frequently does not know the person for whom he prays.
	*Astin JA, Harkness E, Ernst E. The efficacy of “distant healing”: a systematic review of randomized trials. Ann Intern Med 2000;132:903-10.

Spirituality: professional reference. 2002. Available at Onemedicine.com. Cited 2002 Sept 15.

Spirituality and healthcare setting 

The fast pace of modern health care settings, the nursing shortage, the impact of budgetary issues, and managed care changes are concerns that can make any focus on spiritual care difficult. Hospitals with religious affiliations may be expected to handle spiritual care in addition to medical care, but all hospitals need to make that a priority.

Many hospitals and health care systems were begun by orders of religious women. Hospitals such as Catholic Healthcare West and St. Rose Dominican Hospital in Nevada have a long history of formally ministering to faith and healing. Much of that history includes nuns who also may have been nurses. Today, in some settings, that spiritual foundation is expressed in training sessions for nursing staff that address spirituality in the workplace and the influence on the patients and families they serve. Such programs not only emphasize patient healing but also staff spirituality.

A growing alternative to conventional nursing, parish nurses may function as paid nurses or volunteers; they focus on the health care needs, such as screenings, education, prevention, and referrals to community resources, of their congregations. The Health Ministries Association, the professional association for parish nurses, estimates that as many as 10,000 nurses are trained parish nurses.1 For many years, parish nursing was linked primarily to churches rather than hospitals, but recently both systems are reaping the benefits of the expertise parish nurses bring to their communities, particularly in a type of case management for the elderly. Parish nurses often express satisfaction in combining faith and nursing skills in their professional roles.

Other hospital resources 

Health care systems have long made other spiritual resources available to patients. Nurses or physicians who are not comfortable or familiar with spirituality and prayer usually refer patients with spiritual issues to a member of the clergy, a chaplain, pastoral counselor, or other spiritual representative.7 Such professionals discuss spiritual beliefs and concerns with patients and, if appropriate, encourage patients to pray and then pray with them.

Research on spirituality 

Prayer and other spiritual disciplines may improve coping skills and social support, foster feelings of optimism and hope, promote healthy behavior (eg, avoiding tobacco and alcohol), and reduce feelings of depression and anxiety.4 Spiritual practices can induce relaxation and allow people to participate in uplifting rituals.8 Thus, such practices improve stress responses involving neurologic, endocrine, immune, and cardiovascular functions.7 Spiritual disciplines enhance the coping skills of people with chronic illness by reducing uncertainty and promoting self-esteem.

Religious affiliation also is believed to improve quality of life because studies show that regular church attendance improves health and increases longevity.4

Many famous studies have been done on the effect of intercessory prayer on health outcomes. The intuitive sense that mind, body, and spirit are interdependent in health has been supported by several independent epidemiologic observations.9 Clinical trials demonstrate that personal prayer has physiologic effects on the patient similar to those of meditation, including hypertension reduction,7 yet how intercessory prayer works is not clearly understood.4 A possible theory involves the influence of the belief system of the person engaging in spiritual activities or for whom others are praying.10

Five clinical studies were summarized in a recent article that examined the state of the research on prayer and health outcomes. All 5 studies (4 with cardiac patients and 1 with in vitro fertilization patients [IVF]) shared the characteristics important to clinical trials, such as randomized, controlled design, and each study focused on distant prayer as the main intervention. In summary, the patients for whom prayer was held showed generally good outcomes compared with those in the control groups.9 The research on intercessory prayer for cardiac patients indicated that, although length of stay in a coronary care unit (CCU) was not affected, blinded intercessory prayer did reduce morbidity of CCU patients. In essence, the cardiac patients had less postprocedure negative events compared with the control group, and the IVF patients had a 47% term pregnancy rate compared with 22% in the control group.9 The CCU patients and those involved with their medical care were unaware that lay intercessors, who did not know and never met the patients, were praying for them.11

Intercessory prayer also has been reported to reduce pain, fatigue, tenderness, and swelling and to improve grip strength and function for patients with rheumatoid arthritis.8 Such observations are intriguing, and with consistent research designs, the perceived limitations of studies on intercessory prayer will add more to the knowledge of its clinical applications. A review of the literature on the effects of religiosity on psychiatric conditions has shown that 87% of studies found religious involvement had a positive therapeutic effect.12 As with other health conditions, some experts suggest that religious involvement may improve mental health.

Case management implications 

The role of the spirit in health, illness, and recovery from illness is a growing area of interest in modern health care. Although U.S. nursing schools have long incorporated some aspects of spirituality in curricula, many medical schools also have incorporated spiritual teaching into their curricula, with a focus on how to talk to patients about their spiritual beliefs and needs.4 Even so, some health care professionals are unsure what role they should play in assisting or guiding patients in spiritual matters,4 particularly in a setting that does not make that type of care a focus. Similarly, it would be improper to assume that all patients want to discuss spiritual issues, and some may not have any interest in such subjects.

Case managers are often the professionals who interact with the patient and family when difficult or complex decisions need to be made on long-term care, complex care in the home, or other health care issues. An awareness of the renewed interest in prayer can facilitate dialogue with a patient or family who may indicate a desire to have spiritual guidance in health care decisions. Although the case manager may not be directly involved in such a request, knowing how to make referrals to the appropriate team member can be invaluable in meeting client's holistic health needs.

Regardless of whether the case manager, nurse, or other team member assists the family in spiritual requests, when health care professionals engage in spiritual and prayer-based forms of healing, they should do so with an open, accepting, and sensitive attitude that treats all religious beliefs with dignity, respect, and integrity. Spirituality and prayer may be safe and cost-effective adjuncts to medical treatment.8

Table 2 lists resources for more information on spirituality and health care.

Table 2. Resources on Spirituality in Health Care

	American Association of Pastoral Counselors
	Fairfax, VA
	(703) 385-6967
	www.aapc.org
	Health Ministries Association
	Parish Nursing
	Roswell, GA
	(800) 280-9919
	www.healthministriesassociation.org
	National Institute for Healthcare Research
	Rockville, Maryland
	(301) 984-7162
	www.nihr.org